Nurse Billing Auditor

Nurse Billing Auditor (Full Time / Days)

Overlake Medical Center & Clinics

Hourly: $47.95 – $71.93

• Co‑ordinate all procedural and substantive elements relating to the Centers for Medicare & Medicaid (CMS) Recovery Audit Contractor (RAC) program, commercial payer audits and charge capture auditing.
• Prepare activities related to audits performed by a RAC vendor or other payer, including pre‑payment reviews and post‑payment denials.
• Address clinical payment denials and intervene to maximize reimbursement for services rendered by the hospital.
• Serve as a clinical expert on medical necessity criteria, inpatient/observation criteria, and emergency services criteria.
• Prepare defense audits for accounts where a payer has identified discrepancies; review charges originally billed against necessary clinical documentation to identify possible under/over charges; communicate findings to compliance and/or department manager for follow‑up; and maintain communication with external auditors.
• Review and analyze audit reports/RAC findings, investigate trends, and assist facilities in developing and completing plans to influence improvement.

• Associate’s degree in nursing required;
  Bachelor’s degree in nursing preferred.
• Current licensure as a Registered Nurse in the State of Washington is required.
• Minimum five years acute care nursing experience required. Prior utilization management, case management, compliance, or payer experience preferred.

• Local, visible leaders who care about you.
• A values‑based work environment.
• Medical insurance premiums as low as $0 per month.
• Many Overlake services covered at 100%.
• Tuition reimbursement up to $10,000 per year.
• Generous retirement plan matching starting at 5% and increasing to 7% after five years with immediate vesting.
• Pre‑tax and Roth after‑tax retirement savings plans.
• Expanded Employee Assistance Program.
• Caretaker support program to help with everything from childcare to eldercare.
• Free parking and Orca transit passes.

Posted pay ranges represent the entire pay scale, from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional pay based on shift, certification or level of education. Job offers are determined based on a candidate’s years of relevant experience and internal equity.

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