Recovery Audit Contractor Careers: Job Descriptions & Requirements

About this article
What are the pros and cons of a career with a Recovery Audit Contractor (RAC)? Get real job descriptions and training requirements to see if a career with an RAC is right for you.
View available schools

Careers in Recovery Audit Contracting

The Recovery Audit Program was established by the federal government to investigate payment errors and also look for fraud and abuse in the Centers for Medicare and Medicaid Services (CMS) system. Use the table below to learn about two career options for RAC professionals: RAC coordinator and healthcare auditor (also known as claims adjusters, appraisers, examiners and investigators).

RAC Coordinator Healthcare Auditor
Career OverviewRAC coordinators are responsible for all phases of collecting and turning over medical billing information to RACs. Healthcare auditors find billing errors that result in overpayments or underpayments.
Education Requirements Varies; associate's or bachelor's degree in business, health information management or a related field Varies; most employers prefer bachelor's degree or equivalent experience
Program Length 2-4 years Four years
Additional TrainingMedicare billing and CMS processesHealthcare coding software
Certification Voluntary professional certification is available Voluntary professional certification is available
Experience Requirement Varies; several years of related experience typically required* Varies; at least five years of related experience typically required*
Median Salary (2016) Set salary figure is unavailable; RACs typically are paid on a contingency basis** $50,555***

Sources: *Job postings (March 2013), **American College of Emergency Physicians, ***PayScale.com

RAC Coordinator

RAC coordinators may have other related job titles, such as RAC auditor. These coordinators handle the collection of medical billing records with the intention of finding and correcting any payment errors. They frequently work in large healthcare settings like hospitals. Their primary role is to coordinate all aspects of preparation for the auditing process, as well as any appeals or follow-up activities.

Requirements

Educational requirements can vary by employer. An undergraduate degree in a related field, such as health information management, healthcare administration or finance, is the most common general requirement. Employers typically require related experience, such as prior work with medical billing and coding software.

In March 2013, some employers of RAC coordinators were looking for the following:

  • A hospital in Illinois was looking for a part-time employee to handle all aspects of billing audits, including appeals, release of records and follow-up on audit outcomes.
  • A hospital in Wyoming sought a process improvement coordinator/risk manager with a degree in nursing. This position also required handling RAC coordinator responsibilities, including conducting audit processes and ensuring compliance with CMS guidelines.
  • A holding company in Texas sought an RAC coordinator to handle job duties like validating claims, performing quality assurance checks and meeting client accounting goals. Candidates needed at least three years of experience; an undergraduate degree was preferred.

Standing Out

Aspiring RAC coordinators can distinguish themselves by earning designations such as the Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) credentials. The American Health Information Management Association offers these credentials. Requirements vary, but can include professional experience and/or completion of a relevant training program.

Healthcare Auditor

Healthcare auditors may be employed by an RAC to find discrepancies in charges submitted to Medicare by healthcare providers. They are also responsible for implementing plans to recover or return money that has been paid in error. These auditors may supervise other related healthcare workers, such as clerks and analysts.

Requirements

Although specific requirements vary by employer, a bachelor's degree is a common educational requirement. Employers also look for candidates with significant experience in related areas like healthcare fraud investigation or medical billing. Knowledge of healthcare coding, including CPT4, HCPCS, ICD-9 and Revenue Codes, might also be required or preferred.

In March 2013, some employers were looking for the following in healthcare auditors:

  • A Texas healthcare company was seeking a healthcare contract auditor to identify erroneous payments made to healthcare providers and hospitals. Candidates were expected to have at least five years of experience and a bachelor's degree (or equivalent experience).
  • A Massachusetts healthcare company advertised for a healthcare auditor/medical claims analyst to identify payment discrepancies and analyze audit findings, and then report their discoveries to upper management. Ideal job candidates needed 5-7 years of related experience and a bachelor's degree.
  • A network of hospitals in Boston was looking for a full-time managed care contracts coordinator to oversee the process of identifying payment errors, tracking payment recovery and reporting audit findings. Candidates needed familiarity with contract management software.

How to Stand Out

In addition to having the necessary education and/or experience, future auditors may pursue professional certification to demonstrate their skills in the healthcare field. One example is the Certified Professional Medical Auditor (CPMA) credential offered by the AAPC. The CPMA credential requires some experience auditing experience and current AAPC membership. The AAPC recommends having at least an associate's degree before pursuing this credential.

Popular Schools

  • Online Programs Available
    1. Kaplan University

    Program Options

    Master's
      • MS in Accounting - Audit Specialization
      • Master - Accounting
      • MS in Accounting- Tax Specialization
      • MS in Accounting - Government Specialization
      • MS in Accounting - Finance Specialization
      • MBA: Finance
    Bachelor's
      • Bachelor: Auditing-Forensic Accountancy
      • Bachelor: Tax Accountancy
      • Bachelor: Accounting
      • Bachelor: Public-General Accountancy
      • Bachelor: Managerial Accountancy
      • BSBA - Investment
    Associate's
      • Associate: Accounting
      • Associate: Business Admin.
      • Associate: Business Admin. - Office Mgmt
  • Online Programs Available
    2. George Mason University

    Program Options

    Master's
      • Master of Business Administration
  • Online Programs Available
    3. Herzing University

    Program Options

    Master's
      • MBA Dual Concentration: Accounting & Healthcare Mgmt.
      • MBA Dual Concentration: Accounting and Public Safety Leadership
      • MBA
      • MBA Dual Concentration: Accounting and Human Resources
      • MBA Dual Concentration: Business Management and Public Safety Leadership
      • MBA Dual Concentration: Business Mgmt & Project Mgmt.
    Bachelor's
      • Bachelor: Accounting
      • B.S. - Business Management With No Concentration
    Associate's
      • Associate of Science - Accounting
      • Associate of Science - Business Studies
      • Associate of Science - Business Management
    Certificate
      • Diploma: Bookkeeping and Payroll Accounting
  • Online Programs Available
    4. Northcentral University

    Program Options

    Doctorate
      • Doctor of Business Admin - Advanced Accounting
      • PhD in Business Admin - Advanced Accounting
      • PhD in Business Admin - Financial Management
      • Doctor of Business Admin - General Business
      • Doctor of Business Admin - Management
    Master's
      • MBA - Financial Management
      • MS - Accounting
      • Master of Business Admin - General Business
      • Master of Business Admin - Accelerated General MBA
      • MBA - Management
  • Online Programs Available
    5. Seton Hall University

    Program Options

    Master's
      • Master of Business Administration - Accounting
      • Master of Science Professional Accounting
      • Master of Business Administration - Finance
      • Master of Business Administration
  • Online Programs Available
    6. Keiser University

    Program Options

    Bachelor's
      • B.A. - Accounting
      • B.A. - Business Admin: Finance
      • Business Administration, BA - Management
    Associate's
      • Associate of Arts - Accounting
  • Online Programs Available
    7. Johns Hopkins University

    Program Options

    Master's
      • Master of Science in Government Analytics
  • Online Programs Available
    8. Grand Canyon University

    Program Options

    Doctorate
      • DBA - Management
    Master's
      • MBA: Accounting
      • MS in Accounting
      • MBA: Finance
      • MBA
    Bachelor's
      • BS in Accounting
      • Bachelor of Science in Business for Secondary Education
      • BS in Applied Management
      • BS in Finance and Economics
      • BS in Business Admin.
  • Online Programs Available
    9. Georgetown University

    Program Options

    Master's
      • Master of Science in Finance
  • Campus and Online Programs
    10. Full Sail University

    Program Options

    Master's
      • M.S. - Internet Marketing
      • M.S. - Entertainment Business
    Bachelor's
      • B.S. - Music Business

Featured Schools

Kaplan University

  • MS in Accounting - Audit Specialization
  • Bachelor: Auditing-Forensic Accountancy
  • Associate: Accounting

Which subject are you interested in?

George Mason University

  • Master of Business Administration

What is your highest level of education?

Herzing University

  • MBA Dual Concentration: Accounting & Healthcare Mgmt.
  • Bachelor: Accounting
  • Associate of Science - Accounting
  • Diploma: Bookkeeping and Payroll Accounting

What is your highest level of education?

Northcentral University

  • Doctor of Business Admin - Advanced Accounting
  • PhD in Business Admin - Advanced Accounting
  • MBA - Financial Management
  • MS - Accounting

What is your highest level of education?

Seton Hall University

  • Master of Business Administration - Accounting
  • Master of Science Professional Accounting
  • Master of Business Administration - Finance

What is your highest level of education?

Keiser University

  • B.A. - Accounting
  • B.A. - Business Admin: Finance
  • Associate of Arts - Accounting

What is your highest level of education?

Johns Hopkins University

  • Master of Science in Government Analytics

What is your highest level of education?

Grand Canyon University

  • DBA - Management
  • MBA: Accounting
  • BS in Accounting

What is your highest level of education?