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Overnight Medicare Rac Audit Jobs (NOW HIRING)

AHMC Healthcare

Denials Manager RN

San Gabriel, CA · On-site

$53.10/hr

... resources." Medicare defines Medical necessity as "health care services or supplies needed to ... Leads in RAC preparedness and assists facility in the time of RAC Audits. * Participates in ...

AHMC Healthcare

Denials Manager RN

San Gabriel, CA

$53.10 - $58.39/hr

... resources." Medicare defines Medical necessity as "health care services or supplies needed to ... Leads in RAC preparedness and assists facility in the time of RAC Audits. * Participates in ...

CareOne

MDS Specialist RN

Whippany, NJ

$83K - $120K/yr

... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...

CareOne

MDS Specialist RN

Whippany, NJ · On-site

$83K - $120K/yr

... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...

CareOne

MDS Specialist RN

Morristown, NJ

$83K - $120K/yr

... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...

CareOne

MDS Specialist RN

Whippany, NJ

$83K - $120K/yr

... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...

CareOne

MDS Specialist RN

Morristown, NJ

$83K - $120K/yr

... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...

Hanger, Inc.

Clinical Resident

Fort Lauderdale, FL

... education, RAC audit resources, and back office support at one of our more than 700 clinics ... Adhere to all safety regulations; compliance with Medicare, HIPAA and other governmental ...

Caraday Healthcare

MDS-LVN

Austin, TX

$34 - $43.25/hr

Responsible for ensuring appropriate Medicare coverage through regular communication with Clinical ... RAC audits, etc. as needed with professionalism * Coordinate monthly Triple Check meeting for ...

CareOne

MDS Specialist RN

Morristown, NJ · On-site

$83K - $120K/yr

... RAC audits, and pre-payment reviews. * IDT Collaboration & Care Meetings: Facilitate ... Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term ...

Hanger, Inc.

Clinical Resident

Castro Valley, CA

... education, RAC audit resources, and back office support at one of our more than 700 clinics ... Adhere to all safety regulations; compliance with Medicare, HIPAA and other governmental ...

Caraday Healthcare

MDS-LVN

Austin, TX · On-site

$34 - $43.25/hr

Responsible for ensuring appropriate Medicare coverage through regular communication with Clinical ... RAC audits, etc. as needed with professionalism * Coordinate monthly Triple Check meeting for ...

Caraday Healthcare

MDS-LVN

Austin, TX · On-site

$34 - $43.25/hr

Responsible for ensuring appropriate Medicare coverage through regular communication with Clinical ... RAC audits, etc. as needed with professionalism * Coordinate monthly Triple Check meeting for ...

Hanger, Inc.

Clinical Resident

Castro Valley, CA · On-site

... education, RAC audit resources, and back office support at one of our more than 700 clinics ... Adhere to all safety regulations; compliance with Medicare, HIPAA and other governmental ...

Hanger, Inc.

Clinical Resident

Fort Lauderdale, FL · On-site

... education, RAC audit resources, and back office support at one of our more than 700 clinics ... Adhere to all safety regulations; compliance with Medicare, HIPAA and other governmental ...

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All JobsMedicare Rac Audit JobsOvernight Medicare Rac Audit Jobs

Overnight Medicare Rac Audit information

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$19

$46

How much do overnight medicare rac audit jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for overnight medicare rac audit in the United States is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $14.42 and $19.23 per hour, depending on experience, location, and employer.

What is the difference between Overnight Medicare Rac Audit vs Overnight Medicare RAC Auditor?

AspectOvernight Medicare RAC AuditOvernight Medicare RAC Auditor
CredentialsTypically requires healthcare compliance knowledge, auditing certificationsSame as RAC Audit, often requiring healthcare or auditing certifications
Work EnvironmentNight shifts in healthcare or auditing firms, remote or onsiteNight shifts in healthcare compliance departments or auditing firms
Industry UsageUsed by healthcare providers, auditors, and compliance teamsCommonly used by healthcare auditors, compliance specialists, and billing professionals

Both roles involve auditing Medicare claims, but the Overnight Medicare RAC Audit focuses on reviewing and identifying improper payments for recovery audit contractors, while the Overnight Medicare RAC Auditor performs detailed audits to ensure compliance and accuracy in Medicare billing. The main difference lies in the scope: RAC Auditors often work on specific claims, whereas RAC Audits may encompass broader review processes.

How far back do RAC audits go?

RAC (Recovery Audit Contractor) audits typically review Medicare claims from up to three years prior to the date of the audit, though this period can extend to six years in cases of fraud or abuse. As an Overnight Medicare RAC Audit professional, understanding the time limits for claims review is essential for accurate audits and compliance.

How do I become a Medicare auditor?

To become a Medicare auditor, candidates typically need a background in healthcare, accounting, or auditing, along with knowledge of Medicare policies and billing procedures. Relevant certifications such as Certified Professional Coder (CPC) or Certified Public Accountant (CPA) can enhance prospects, and experience with audit tools or software is beneficial. Job requirements often include strong analytical skills and attention to detail, with positions available through government agencies or private firms involved in healthcare compliance.

What type of auditor gets paid the most?

In the auditing field, senior auditors, especially those with specialized skills like Medicare or healthcare audit expertise, tend to earn the highest salaries. Experienced auditors with certifications such as CPA or CIA and those working in senior or managerial roles generally receive higher pay, particularly in complex or regulated environments like healthcare reimbursement audits.

Is a Night Auditor an entry level position?

A Night Auditor is often considered an entry-level position in the hospitality industry, requiring basic accounting, customer service skills, and familiarity with hotel management software. However, some employers prefer candidates with previous experience or certifications, and the role may involve overnight shifts and handling guest inquiries. In the context of healthcare or insurance audits, roles with similar titles may require specialized knowledge or experience.
More about Overnight Medicare Rac Audit jobs
What cities are hiring for Overnight Medicare Rac Audit jobs? Cities with the most Overnight Medicare Rac Audit job openings:
What are the most commonly searched types of Medicare Rac Audit jobs? The most popular types of Medicare Rac Audit jobs are:
What states have the most Overnight Medicare Rac Audit jobs? States with the most job openings for Overnight Medicare Rac Audit jobs include:
What job categories do people searching Overnight Medicare Rac Audit jobs look for? The top searched job categories for Overnight Medicare Rac Audit jobs are:
Overnight Medicare Rac Audit jobs near you
Infographic showing various Overnight Medicare Rac Audit job openings in the United States as of June 2026, with employment types broken down into 84% Full Time, 11% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.
Denials Manager RN

Denials Manager RN

AHMC Healthcare

San Gabriel, CA • On-site

$53.10/hr

Full-time

Posted 22 days ago

AHMC Healthcare rating

7.1

Company rating: 7.1 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

Job description

Overview
The Denials Case Manager, RN appeals all denials using InterQual criteria and medical necessity. Collaboratively works with all members of the revenue cycle team and all types of payers to resolve denials, maximize accurate and timely reimbursement, and perform reimbursement recovery and retention service. Evaluates, tracks and trends denials, and implements denial prevention programs. Works in collaboration with Case Managers, Physicians, Finance and multidisciplinary teams to ensure compliance with documentation and educates as needed.
This position requires the full understanding and active participation in fulfilling the Mission of San Gabriel Valley Medical Center. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support San Gabriel Valley Medical Center's strategic plan and the goals and direction of the Performance Improvement Plan (PIP).
According to the American Case Management Association Standard of Practice, Case Management is expected to "advocate for the patient while balancing the responsibility of stewardship for their organization, and in general, the judicious management of resources."
Medicare defines Medical necessity as "health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine."
Responsibilities
Specific Job Duties:
  1. Ensures template for appeals includes reason for denial, diagnosis codes, MCG criteria used to support appeal, highlights of medical necessity supporting appeal, and only supporting documents necessary to support appeal are submitted with appeal template.
  2. Has knowledge of appeal deadlines and ensures appeals are submitted within this timeframe. Tracks responses to appeals, follows-up as appropriate.
  3. Working knowledge of levels of appeals, time lines, and contractual requirements related to appeals.
  4. Works with payers to resolve issues related to underpayments or increased denial trends.
  5. Ensures working knowledge of contracts to ensure appropriate reimbursement.
  6. Works closely with facility department directors such as Admitting, Case Management, Patient Accounting and CBO Directors to review, resolve and streamline all necessary aspects of the appeals process
  7. Establish appropriate tool for measuring Denial Tracking and Trending. Tracks and trends data, identifies opportunities for improvement, and establishes process improvement strategies as appropriate.
  8. Works closely with Case Managers regarding the Peer to Peer process for concurrent denials. Ensures they are completed within timeframes and logged. Creates a peer to peer report on weekly/monthly basis for presentation at denials meetings.
  9. May be asked to provide education and training to the Medical Staff, Nursing staff and or others related to denial prevention.
  10. Leads in RAC preparedness and assists facility in the time of RAC Audits.
  11. Participates in Continued Education in current laws that prevent unlawful denials, California Code of Regulations and HMO Compliance. Attends training and develops relevant knowledge and skills related to any identified gaps.
  12. Participates in all Corporate and Facility based Denials Meeting
  13. Participates in Utilization Management and other meetings regarding denials, and audits as necessary.
  14. Other responsibilities deems necessary as delegated. regarding denials and denials prevention
  15. Performs other duties as assigned.

Qualifications
Minimum Qualifications
  • Graduate of an accredited RN School of Nursing
  • BSN preferred
  • Four years recent acute care experience in a critical care setting (preferred)
  • Two years Utilization Management/Case Management experience
  • Working knowledge of MCG, Intensity of Service/Severity of Illness criteria.
  • Working knowledge of Title XXII and Title XIX.
  • Working knowledge of reimbursement related to Medicare, Medi-Cal, Capitation, Shared Risk, and Managed Care.
  • Ability to negotiate with the physicians, payers, and customers.
  • Ability to track outcomes and report findings.
  • Able to problem solve effectively.
  • Ability to use clinical knowledge to identify potential quality issues.
  • Provides proper notification of absence or tardiness within established departmental time frames.

Licenses/Certifications
Current California RN License
Current BLS Card

What AHMC Healthcare employees say

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About AHMC Healthcare

Sourced by ZipRecruiter

Caring for you and your loved ones is our top priority. We encourage our patients to be involved in the care process, and to communicate with our staff about their experience. From our admitting staff, to nurses, patient experience managers, and administration - we're here because we care. Physicians and facility staff are dedicated to achieving the highest level of clinical excellence. AHMC Healthcare hospitals have advanced diagnostics tools such as the MRI GE Signa HDxt1.5TMR system and the Toshiba Aquilon 128-slice CT scanner. Anaheim Regional Medical Center's Heart Center has the second largest volume of open heart surgeries in Orange County. Members of our Nursing staff have been recognized at the Hospital Heroes Awards and the SeniorServ Senior Care Hero Awards. Whichever AHMC Healthcare hospital you choose, you will be choosing a facility dedicated to delivering quality service and care.

Company size

5,001 - 10,000 Employees

Headquarters location

Alhambra, CA, US

Year founded

2004

Social media

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