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Cms Auditor Jobs in Indiana (NOW HIRING)

Methodist Hospitals

CODING AUDITOR

Merrillville, IN · On-site

$26.75 - $30.50/hr

Maintains working knowledge of CMS (Medicare and Medicaid) regulations, Local Coverage Determinations (LCD), National Coverage determination (NCD) and National Correct Coding Initiatives (NCCI)

Methodist Hospitals

CODING AUDITOR

Merrillville, IN · On-site

$25.50 - $28.75/hr

Maintains working knowledge of CMS (Medicare and Medicaid) regulations, Local Coverage Determinations (LCD), National Coverage determination (NCD) and National Correct Coding Initiatives (NCCI)

Methodist Hospitals

CODING AUDITOR

Merrillville, IN · On-site

$26.75 - $30.50/hr

Maintains working knowledge of CMS (Medicare and Medicaid) regulations, Local Coverage Determinations (LCD), National Coverage determination (NCD) and National Correct Coding Initiatives (NCCI)

Methodist Hospitals

CODING AUDITOR

Merrillville, IN · On-site

$26.75 - $30.50/hr

Maintains working knowledge of CMS (Medicare and Medicaid) regulations, Local Coverage Determinations (LCD), National Coverage determination (NCD) and National Correct Coding Initiatives (NCCI)

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Cms Auditor information

What are the key skills and qualifications needed to thrive as a CMS auditor?

To thrive as a CMS Auditor, you need expertise in healthcare compliance, detailed knowledge of Centers for Medicare & Medicaid Services (CMS) regulations, and a background in auditing or healthcare administration. Familiarity with claims review software, electronic health records (EHR) systems, and relevant certifications such as Certified Professional Medical Auditor (CPMA) or Certified Internal Auditor (CIA) is highly valued. Strong analytical thinking, meticulous attention to detail, and effective communication skills are essential for working with healthcare providers and team members. These skills ensure accurate audit findings, regulatory compliance, and effective collaboration in the evolving healthcare landscape.

What is a CMS auditor?

A CMS Auditor is responsible for reviewing and assessing compliance with the Centers for Medicare & Medicaid Services (CMS) regulations. They conduct audits of healthcare organizations, insurance providers, or related entities to ensure adherence to policies, billing accuracy, and regulatory standards. Their role involves analyzing documentation, identifying non-compliance issues, and recommending corrective actions. Strong knowledge of healthcare laws, risk assessment, and auditing practices is essential for success in this role.

What are some common challenges faced by CMS auditors, and how can they be managed?

CMS Auditors often navigate the complexities of changing federal and state regulations as well as diverse healthcare billing practices, which can make audits both detailed and challenging. Staying current with regulatory updates, maintaining strong documentation habits, and leveraging audit management tools can help manage these challenges effectively. Regular training and open communication with providers and compliance teams also support accurate, efficient auditing. While the work can be demanding, it offers valuable opportunities to impact healthcare quality and prevent fraud, which many auditors find rewarding.

What are the most commonly searched types of Cms Auditor jobs in Indiana? The most popular types of Cms Auditor jobs in Indiana are:
What are popular job titles related to Cms Auditor jobs in Indiana? For Cms Auditor jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Cms Auditor jobs in Indiana look for? The top searched job categories for Cms Auditor jobs in Indiana are:
Cms Auditor jobs near you
Infographic showing various Cms Auditor job openings in Indiana as of August 2026, with employment types broken down into 3% As Needed, 80% Full Time, 13% Part Time, and 4% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Claims Auditor- Remote

American Health Partners

Indianapolis, IN • Hybrid

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 2 days ago

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. 

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! 

Benefits and Perks include:

  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleMedicine 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts
  • Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. 

  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
  • Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
  • Work assigned claim projects to completion
  • Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
  • Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
  • Maintain production and quality standards as established by management
  • Participate in and support ad-hoc audits as needed
  • Other duties as assigned

JOB REQUIREMENTS:

  • Proficient in processing/auditing claims for Medicare and Medicaid plans
  • Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
  • Current experience with both Institutional and Professional claim payments
  • Knowledge of automated claims processing systems
  • Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

  • Experience:
    • Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
    • Two (2) years’ experience in managed healthcare environment related to claims processing/audit
    • Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
    • Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
    • Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
  • License/Certification(s):
    • Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

 This employer participates in E-Verify.

American Health Partners logo

About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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