Nurse Billing Auditor (Full Time / Days)

Overlake Medical Center & Clinics•Bellevue, WA

19d•$48 - $72

About The Position

Welcome to a medical center where you're the center of attention. Pay range: - Hourly $47.95 - $71.93 Responsible for the coordination of 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 any activities pertaining to audits performed by a RAC vendor or other payer i.e., prepayment reviews, post payment denials, etc. Address clinical payment denials and intervene to maximize reimbursement for the 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 any charge findings to compliance and/or the department manager for follow up; and maintain communication with external auditors. Review and analyze audit reports/RAC findings, investigate trends, and assist facilities in development and completion of plans to influence improvement. Full Time / Days Qualifications: 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. Why join Overlake? We're proud to offer benefits that support you in every stage of your career and life. But it's our inspirational culture that has made us one of America's Top 150 places to work in healthcare for several years in a row. 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. An expanded Employee Assistance Program. A caregiver support program to help with everything from childcare to eldercare. Free parking and Orca transit passes. If this sounds like an environment where you'll thrive, we'd love to hear from you. How much will this job pay? 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. If you have questions about Overlake's pay practices, employee benefits or the pay for a specific position, please contact [email protected] Overlake Medical Center is a 349-bed, nonprofit regional medical center offering a full range of advanced medical services to the Puget Sound region. Led by a volunteer board of trustees, we employ nearly 3,000 people and have some 1,000 active and courtesy providers on our medical staff, including more than 200 providers who are employed by the organization. We were the first Level III Trauma Center on the Eastside and we are known for providing award-winning, compassionate and patient-centered care. Our commitment to maintaining the highest standards in medical care is a major reason our patients and their families choose Overlake. It is also the reason why we've received many awards and recognitions both regionally and nationally. Overlake was started by community volunteers, and still depends upon volunteers to support the operations of the hospital. Find out more about volunteer opportunities. To find out how to get to Overlake, view our maps and directions. Overlake has a variety of publications that you can receive in your home for added health and wellness information in addition to our annual report. We also produce a community health needs assessment (CHNA) and Implementation Strategy to help us outline how the hospital will give back to the community in the form of health care and other community health services to address unmet community needs. For questions and comments related to CHNA, please email us. COVID-19 vaccination requirement: After October 18, 2021 all Washington state healthcare employees, contractors and volunteers will be required to provide proof of full COVID-19 immunization as a condition of employment. You must provide this proof before your first day of employment with Overlake. Please remember to bring your COVID-19 immunization card to your pre-hire health screening with our Employee Health team.

Requirements

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.
COVID-19 vaccination requirement: After October 18, 2021 all Washington state healthcare employees, contractors and volunteers will be required to provide proof of full COVID-19 immunization as a condition of employment. You must provide this proof before your first day of employment with Overlake. Please remember to bring your COVID-19 immunization card to your pre-hire health screening with our Employee Health team.

Nice To Haves

Bachelor's degree in nursing preferred.
Prior utilization management, case management, compliance, or payer experience preferred.

Responsibilities

Responsible for the coordination of 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 any activities pertaining to audits performed by a RAC vendor or other payer i.e., prepayment reviews, post payment denials, etc.
Address clinical payment denials and intervene to maximize reimbursement for the 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 any charge findings to compliance and/or the department manager for follow up; and maintain communication with external auditors.
Review and analyze audit reports/RAC findings, investigate trends, and assist facilities in development and completion of plans to influence improvement.

Benefits

We're proud to offer benefits that support you in every stage of your career and life.
But it's our inspirational culture that has made us one of America's Top 150 places to work in healthcare for several years in a row.
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.
An expanded Employee Assistance Program.
A caregiver support program to help with everything from childcare to eldercare.
Free parking and Orca transit passes.