Clinical RAC Auditor

Join to apply for the Clinical RAC Auditor role at Sentara Health

The Recovery Audit Contractor (RAC) Auditor is responsible for determining the clinical necessity that supports the claim in accordance with the respective contract while also coordinating the disposition of the denied claim with the appropriate personnel.

• Demonstrate an understanding of Medicare and other payer guidelines related to billing and charging of observation services, other separately chargeable services, and other lines of service.
• Utilize knowledge of managed care contracting arrangements as well as notification and clinical review requirements.
• Apply regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity.
• Perform functions including internal auditing, coder education, and liaison with external auditors for corporate audits.
• Interpret medical records, hospital bills, and Charge Master information.

• Registered Nurse license required.
• CPC or CCS required within 6 months of hire.
• 5 years Acute Care Coding experience required.
• Previous healthcare auditing experience preferred.
• RN Bachelor Level Degree or 2‑year RN Associate Degree or RN Diploma acceptable.

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long‑Term, Short‑Term Disability, and Critical Illness plans
• Life Insurance
• 401(k)/403(b) with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Annual discretionary bonus eligibility

Norfolk, VA

First (Days)

• Alabama
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• Indiana
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• Maine
• Maryland
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• New Hampshire
• North Carolina
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Hospitals and Health Care

Accounting/Auditing and Finance

Mid‑Senior level

Full‑time

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco‑free environment.