Job Overview

Recovery Audit Contractor (RAC)

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.

  • Must 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.
  • Must demonstrate knowledge of managed care contracting arrangements as well as notification and clinical review requirements.
  • Must also be knowledgeable of regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity. Possess the ability to perform a number of functions including those of internal auditing, coder education, liaison with external auditors for corporate audits.
  • Registered Nurse license required.

Demonstrates the minimum knowledge, skills and abilities to recognize for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Ability to understand and interpret medical records, hospital bills and Charge Master. Must 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. Must demonstrate knowledge of managed care contracting arrangements as well as notification and clinical review requirements. Must also be knowledgeable of regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity.

CPC or CCS required within 6 months of hire. Previous Healthcare Auditing experience preferred.

 

Education

  • RN Bachelor Level Degree
  • 2 yr RN Associate Degree
  • RN Diploma

Certification/Licensure

  • CPC or CCS required within 6 months of hire.
  • Previous Healthcare Auditing experience preferred

Experience

  • Demonstrates the minimum knowledge, skills and abilities to recognize for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices
  • Ability to understand and interpret medical records, hospital bills and Charge Master.
  • Must 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.
  • 5 years Acute Care Coding experience required
  • Registered Nurse required

Registered Nurse Coding Acute Care Medicare

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission – “we improve health every day.” Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina including 10 hospitals with the prestigious Magnet® recognition, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety, and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as “America’s Best-In-State Employer” (2024), “Best Employer for Veterans” (2022, 2023), and “Best Employer for Women” (2020), and named to IBM Watson Health’s “Top 15 Health Systems” (2021, 2018).

Learn more

A woman smiling as a healthcare worker helps her with arm exercises in a bright, sunlit room.
A woman smiling as a healthcare worker helps her with arm exercises in a bright, sunlit room.
A woman smiling as a healthcare worker helps her with arm exercises in a bright, sunlit room.

Our Culture

At Sentara, our differences are our strengths. The unique backgrounds, skills, and experiences that each Sentara colleague brings to work make Sentara special and allow us to deliver excellent service and care to our patients, members, and communities.

Our Benefits

We are committed to consistently enhancing our training, advancement tracks, work-life benefits, and more. Our goal is to make you feel more excited to be here every day!

Two female doctors in lab coats smiling and chatting in a hospital hallway.
Two female doctors in lab coats smiling and chatting in a hospital hallway.
Two female doctors in lab coats smiling and chatting in a hospital hallway.
Two nurses in scrubs smiling and chatting during a break, one holding a coffee cup in a bright hospital setting.
Two nurses in scrubs smiling and chatting during a break, one holding a coffee cup in a bright hospital setting.

The Sentara Nursing Experience

Making a meaningful impact on health requires compassion, dedication, continuous learning, teamwork and collaboration. At Sentara, we also recognize that in valuing the professional and personal well-being of our nurses, we build a stronger, more supportive workplace for our nurses. And that’s making us healthier from the inside out. These principles unite our nurses across various roles and locations.

Two nurses in scrubs smiling and chatting during a break, one holding a coffee cup in a bright hospital setting.
Surgical assistant in scrubs and mask operates medical monitor in an operating room with other staff in the background.

The Sentara Clinical Experience

No matter where you choose to join us, in an inpatient or outpatient setting, you will be part of an interdisciplinary Clinical team passionate about quality care and patient safety. You will have access to the tools and technologies you need to succeed and the chance to learn and grow through training and educational programs so you can advance your career as a Clinical professional.

Smiling healthcare worker assists a male patient at a clinic front desk while another nurse works in the background.

The Sentara Support Services Experience

Each day, the Sentara Support Services team helps improve healthcare at more than 300 Virginia and Northeastern North Carolina sites. We perform various patient care activities, provide multiple services, and handle administrative functions that support our patients and their families. These vital functions include assisting the medical team in all aspects of medical care, such as treatments, procedures, and diagnostic and laboratory testing.

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The Medical Group Experience

As part of Sentara Health, Sentara Medical Group providers have diverse opportunities across regions and inpatient and outpatient locations. For those providers based in one of 12 hospitals, we have close working relationships with the administration, ensuring a collegial and collaborative environment where all can come together around shared initiatives.

Guided by a dedicated board of providers, Sentara Medical Group not only offers leadership opportunities for its providers but also underscores the group’s crucial role in fulfilling Sentara’s overarching mission to meet the needs of our diverse patient populations, some of our most vulnerable communities. Our physicians and APPs enjoy opportunities for both personal and professional career growth through a network of resources aimed to cultivate an environment suitable for a lifelong career home.

Your Perspective Matters

Nurses are the heartbeat of our exceptional team. Our approach empowers nurses to actively participate in decision-making. Our nurses have a stake in shaping their workplace as well as their own career growth; one of the benefits of our focus on supporting and valuing team members. This framework encompasses our nursing mission, vision, values, philosophy, and the essential elements of our Professional Practice Model.

This image illustrates the Sentara Nursing Professional Practice Model. Read more about it on The Sentara Nurse Experience page.

Visual representation of the Sentara Nursing Professional Practice Model.

Our Award-Winning Care

Forbes 2024 America's Best-In-State Employers. Powered by Statista
Forbes 2023 The Best Employers for Veterans. Powered by Statista.
Virginia Values Veterans. Official V3 Certified Company
America's Greatest Workplaces for Women 2025. Newsweek. Plant-A Insights Group
2024 Health Quality Innovator of the Year
2024 LGBTQ+ Healthcare Equality High Performer. Human Rights Campaign. Healthcare Equality Index.
Magnet Recognized. American Nurses Credentialing Center.

We Are an Equal Opportunity Employer

Sentara Health is an Equal Opportunity Employer committed to the hiring, advancement, and fair treatment of every individual. Sentara and its affiliates do not discriminate against any individual or group of individuals on the basis of race, color, religion, ancestry, national origin, marital status, age, sex, sexual orientation, gender identity or expression, genetic information, physical or mental disability, pregnancy, medical condition, veteran status or any other legally protected characteristics.

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We Are an Equal Opportunity Employer

Sentara Health is an Equal Opportunity Employer committed to the hiring, advancement, and fair treatment of every individual. Sentara and its affiliates do not discriminate against any individual or group of individuals on the basis of race, color, religion, ancestry, national origin, marital status, age, sex, sexual orientation, gender identity or expression, genetic information, physical or mental disability, pregnancy, medical condition, veteran status or any other legally protected characteristics.

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