Position Overview:

The Enterprise RAC Audit Manager is responsible for the strategic oversight and day-to-day management of all Recovery Audit Contractor (RAC) activity across the organization. This role serves as the primary liaison between corporate revenue cycle leadership, facility leadership, compliance, and external audit entities to ensure timely, accurate, and compliant management of all RAC requests.

The Enterprise RAC Audit Manager oversees audit workflows, monitors performance metrics and trends, identifies opportunities for operational improvement, and provides executive-level reporting to support organizational decision-making. This position plays a critical role in minimizing financial risk, improving audit outcomes, and driving enterprise-wide standardization of RAC processes.

Responsibilities:

Enterprise RAC Program Oversight

• Manage the enterprise-wide RAC audit program across all facilities.
• Serve as the primary point of contact for all RAC-related activities.
• Monitor incoming RAC requests to ensure timely assignment and completion.
• Ensure all audit deadlines are met, and escalation occurs when timelines are at risk.
• Maintain centralized oversight of all active and completed RAC audits.

Operational Management

• Track outstanding documentation requests and follow up with facilities as needed.
• Coordinate with facility leadership to obtain required medical records and supporting documentation.
• Monitor audit progression from initial request through final determination.
• Ensure accurate tracking of appeal status and financial impact.
• Identify barriers delaying audit completion and develop corrective action plans.

Data Analysis & Reporting

• Develop and maintain enterprise RAC dashboards and reporting.
• Analyze audit volumes, outcomes, denial reasons, overturn rates, and financial impact.
• Identify recurring trends by:
• Facility
• Region
• Payer
• Service line
• Procedure
• Audit issue
• Present findings and recommendations to senior leadership.
• Provide routine executive summaries highlighting risks, opportunities, and performance.

Communication & Stakeholder Management

• Serve as the liaison between:
• Corporate Revenue Cycle
• Facility Leadership
• Coding External audit vendors
• Communicate audit status, outstanding needs, and critical deadlines.
• Facilitate discussions to resolve audit related issues.
• Escalate high risk or high dollar audits appropriately.

Process Improvement

• Evaluate existing RAC workflows and recommend process improvements.
• Standardize enterprise RAC processes and documentation.
• Develop best practices to improve audit response times and appeal success.
• Partner with operational teams to reduce recurring audit findings.
• Identify education opportunities based on audit trends.

Education & Training

• Develop educational materials related to RAC audits.
• Conduct training sessions for facility leadership and revenue cycle teams.
• Educate departments on audit expectations, documentation requirements, and common findings.
• Share lessons learned from completed audits to reduce future risk.

Compliance & Quality

• Ensure RAC processes remain compliant with regulatory requirements.
• Monitor adherence to internal policies and audit response standards.
• Validate documentation submitted for completeness and accuracy.
• Maintain organized audit documentation for reporting and future reference.

Leadership Support

• Prepare presentations and reporting for senior leadership.
• Provide recommendations based on audit performance and emerging risks.
• Support strategic initiatives related to audit readiness and revenue integrity.

Key Performance Indicators

• Timeliness of RAC response submissions
• Audit turnaround time
• Outstanding request aging
• Dollars at risk
• Dollars recovered
• Audit volume by facility
• Recurring denial trends
• Reduction in repeat audit findings
• Completion of education initiatives
• Accuracy and timeliness of executive reporting