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Cms Auditor Jobs (NOW HIRING)

Independent Living Systems

Claims Auditor

Miami, FL · On-site

We are seeking a Claims Auditor to join our team at Independent Living Systems (ILS). ILS, along ... as HIPAA and CMS guidelines. * Proficiency in audit software and Microsoft Office Suite ...

Montefiore

Senior Coding Auditor

South Broadway, WA

$81K - $99K/yr

The Senior Coding Auditor reviews and audits current and retro accounts, and reports audit outcomes ... Knowledge of regulatory agencies requirements (JCAHO, CMS & Medicaid) and remain current on new ...

Montefiore

Senior Coding Auditor (JR229354)

Tarrytown, NY

$85K - $105K/yr

Overview Job Summary The Senior Coding Auditor performs detailed audits of medical cases to ensure ... Knowledge of regulatory agencies requirements (JCAHO, CMS & Medicaid) and remain current on new ...

BHC ISC

PBO Coding Educator & Auditor

Fort Lauderdale, FL · On-site

$26 - $29.75/hr

... and Medicaid (CMS) guidelines and policies. Oversees coding auditors to ensure the accuracy of audits identifies opportunities for improvement and implements corrective resolutions to assure ...

Health Source MSO

Claims Auditor

Alhambra, CA · On-site

Claims Auditor will be responsible for auditing claims processed by Claims Examiners ... Must be familiar with facility (UB-04) and professional (CMS-1500) claim billing practices. Must ...

Cotiviti

Senior Auditor Appeals - OPSP

$82K - $101K/yr

... CMS inpatient and outpatient coding guidelines, coding clinics, and internal clinical validation policies if applicable. The appeals auditor is responsible for performing an extensive review of the ...

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Cms Auditor information

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$33K

$76.3K

$121.5K

How much do cms auditor jobs pay per year?

As of Jul 23, 2026, the average yearly pay for cms auditor in the United States is $76,256.00, according to ZipRecruiter salary data. Most workers in this role earn between $53,500.00 and $98,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Cms Auditor position, and why are they important?

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 job?

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.

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What cities are hiring for Cms Auditor jobs? Cities with the most Cms Auditor job openings:
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Cms Auditor jobs near you
Infographic showing various Cms Auditor job openings in the United States as of July 2026, with employment types broken down into 89% Full Time, 8% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 6% Hybrid, and 7% Remote job distribution, with an average salary of $76,256 per year, or $36.7 per hour.

Quality Control Auditor

LSMA Management Inc

San Bernardino, CA

$28.85 - $33.65/hr

Other

Posted 2 days ago

Job description

Description

JOB SUMMARY


The Quality Control Auditor - Claims Management is responsible for performing detailed audits of claims processing activities to ensure accuracy, regulatory compliance, and adherence to contractual, coding, and reimbursement requirements within the Managed Services Organization (MSO). This role evaluates claims adjudication performed by Claims Examiners, identifies errors, analyzes trends, and provides recommendations to improve claims accuracy, operational efficiency, and compliance with federal and California regulatory standards.

The Quality Control Auditor supports delegated managed care compliance by auditing claims in accordance with health plan contracts, coding standards, reimbursement methodologies, and applicable regulatory requirements, including Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), and Department of Health Care Services (DHCS) standards where applicable.

This role plays a critical role in maintaining claims processing integrity, minimizing financial risk, ensuring regulatory compliance, and supporting continuous operational improvement.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS


Education/Training

Minimum: High School Diploma or equivalent.

Preferred: Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Compliance, or related field.

Experience 

Minimum: At least five years of managed care claims auditing, claims examiner, or claims quality control experience. Two years of experience as a Claims   Examiner or Claims Adjuster. 

Preferred: Experience in MSO, IPA, or health plan environment. Experience supporting delegated managed care and regulatory audits. Experience auditing   professional and institutional claims.

Certification(s)

Preferred: Certified Professional Coder (CPC), Certified   Professional Medical Auditor (CPMA), or Certified Professional Compliance Officer (CPCO)


Skills, Knowledge & Abilities

Strong knowledge of managed care claims processing and audit methodologies.

Knowledge of CPT, HCPCS, ICD-10, DRG, and reimbursement methodologies. 

Knowledge of health plan contracts, fee schedules, and DOFR agreements. 

Knowledge of DMHC, CMS, DHCS, and regulatory requirements.

Strong analytical and problem-solving skills.

Ability to interpret and apply complex regulatory and contractual requirements.

Strong attention to detail and audit documentation skills.

Excellent written and verbal communication skills. 

Proficiency with claims systems such as EZ Cap and Microsoft Office applications. 

Ability to work independently and meet audit   deadlines.

Ability to maintain confidentiality and data integrity.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and involves prolonged periods of sitting, computer use, and document review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure claims accuracy and regulatory compliance. Light physical effort may be required, including lifting up to approximately 10 pounds and occasional bending, reaching, or filing. This role requires the ability to maintain confidentiality and professionalism when handling sensitive claims and compliance information.


PAY RANGE

$28.85 - $33.65 / hourly

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