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 Overview | RAC 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 Training | Medicare billing and CMS processes | Healthcare 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.
