Maintain currency on CMS and state Medicaid managed care claims processing rules, including ... and ability to adjust focus. * Work across multiple time zones in a hybrid or remote work ...
Maintain currency on CMS and state Medicaid managed care claims processing rules, including ... and ability to adjust focus. * Work across multiple time zones in a hybrid or remote work ...
Auditor Clinical Validation DRG
$45.67/hr
Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Auditor Clinical Validation DRG
$45.67/hr
Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Senior Auditor
Albany, NY · On-site
$100K - $125K/yr
... using CMS tools such as OnePI, STARS, Business Objects, and other related platforms. -Prepare ... focus. -Work collaboratively with attorneys and investigators to refine leads and develop ...
Quick apply
Senior Auditor
Albany, NY · On-site
$100K - $125K/yr
... using CMS tools such as OnePI, STARS, Business Objects, and other related platforms. -Prepare ... focus. -Work collaboratively with attorneys and investigators to refine leads and develop ...
Senior Auditor
Albany, NY · On-site
$100K - $125K/yr
... using CMS tools such as OnePI, STARS, Business Objects, and other related platforms. -Prepare ... focus. -Work collaboratively with attorneys and investigators to refine leads and develop ...
Senior Auditor
Albany, NY · On-site
$100K - $125K/yr
... using CMS tools such as OnePI, STARS, Business Objects, and other related platforms. -Prepare ... focus. -Work collaboratively with attorneys and investigators to refine leads and develop ...
Senior Auditor
Albany, NY · On-site
$100K - $125K/yr
... using CMS tools such as OnePI, STARS, Business Objects, and other related platforms. -Prepare ... focus. -Work collaboratively with attorneys and investigators to refine leads and develop ...
Senior Auditor
Albany, NY · On-site
$100K - $125K/yr
... using CMS tools such as OnePI, STARS, Business Objects, and other related platforms. -Prepare ... focus. -Work collaboratively with attorneys and investigators to refine leads and develop ...
... focus on government programs such as Medicare and Medicaid. Responsibilities include working with ... CMS) coverage guidelines * Conduct analysis of audit findings to identify trends/problems in coding ...
... focus on government programs such as Medicare and Medicaid. Responsibilities include working with ... CMS) coverage guidelines * Conduct analysis of audit findings to identify trends/problems in coding ...
Coding Quality Auditor (RN)
Coupeville, WA · On-site
$26.50 - $30/hr
... focus on Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF ... Ensure adherence to CMS regulations, risk adjustment guidelines, and payer-specific requirements
Coding Quality Auditor (RN)
Coupeville, WA · On-site
$26.50 - $30/hr
... focus on Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF ... Ensure adherence to CMS regulations, risk adjustment guidelines, and payer-specific requirements
Coding Quality Auditor (RN)
Coupeville, WA · On-site
$95K - $133K/yr
... focus on Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF ... Ensure adherence to CMS regulations, risk adjustment guidelines, and payer-specific requirements
Coding Quality Auditor (RN)
Coupeville, WA · On-site
$95K - $133K/yr
... focus on Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF ... Ensure adherence to CMS regulations, risk adjustment guidelines, and payer-specific requirements
... focus on government programs such as Medicare and Medicaid. Responsibilities include working with ... CMS) coverage guidelines * Conduct analysis of audit findings to identify trends/problems in coding ...
... focus on government programs such as Medicare and Medicaid. Responsibilities include working with ... CMS) coverage guidelines * Conduct analysis of audit findings to identify trends/problems in coding ...
Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Overview This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Inpatient Coding Auditor
Pittsburgh, PA · On-site
$26.50 - $30/hr
We maintain an unrelenting focus on quality, client success, and team member growth. * Our PEOPLE ... CMS directives. The auditor also validates Present on Admission (POA) indicators per AHA POA ...
Quick apply
Inpatient Coding Auditor
Pittsburgh, PA · On-site
$26.50 - $30/hr
We maintain an unrelenting focus on quality, client success, and team member growth. * Our PEOPLE ... CMS directives. The auditor also validates Present on Admission (POA) indicators per AHA POA ...
Ensure coding compliance with CMS, commercial payer, and regulatory guidelines. * Identify and ... focus * While performing the duties of this job, the employee is regularly required to talk and ...
Quick apply
Ensure coding compliance with CMS, commercial payer, and regulatory guidelines. * Identify and ... focus * While performing the duties of this job, the employee is regularly required to talk and ...
Medical Coding Auditor - Surgical Services
Dallas, TX · On-site +1
Ensure coding compliance with CMS, commercial payer, and regulatory guidelines. * Identify and ... focus * While performing the duties of this job, the employee is regularly required to talk and ...
Medical Coding Auditor - Surgical Services
Dallas, TX · On-site +1
Ensure coding compliance with CMS, commercial payer, and regulatory guidelines. * Identify and ... focus * While performing the duties of this job, the employee is regularly required to talk and ...
Auditor Clinical Validation DRG - US Remote
Salt Lake City, UT · Remote
$45.67/hr
This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Auditor Clinical Validation DRG - US Remote
Salt Lake City, UT · Remote
$45.67/hr
This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ... Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory ...
Coding Educator & Auditor
Omaha, NE · On-site
$26 - $29.75/hr
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we ... Reviews CMS mandates and updates coding directives as needed. * Reviews Federal Register to ensure ...
Coding Educator & Auditor
Omaha, NE · On-site
$26 - $29.75/hr
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we ... Reviews CMS mandates and updates coding directives as needed. * Reviews Federal Register to ensure ...
Professional Billing (PB) Auditor - Surgical Specialty
Gulfport, FL · On-site
$18 - $20.50/hr
Ensure compliance with CMS, AMA, and payer-specific billing regulations Requirements: Required Qualifications: * Minimum 3+ years of professional billing auditing experience with a focus on surgical ...
Quick apply
Professional Billing (PB) Auditor - Surgical Specialty
Gulfport, FL · On-site
$18 - $20.50/hr
Ensure compliance with CMS, AMA, and payer-specific billing regulations Requirements: Required Qualifications: * Minimum 3+ years of professional billing auditing experience with a focus on surgical ...
Healthcare Delivery Auditor
Austin, TX · On-site
... with a focus on chart audits, service documentation, provider billing practices, and care ... Working knowledge of healthcare regulations (e.g., CMS, Medicaid, HIPAA), documentation standards ...
Healthcare Delivery Auditor
Austin, TX · On-site
... with a focus on chart audits, service documentation, provider billing practices, and care ... Working knowledge of healthcare regulations (e.g., CMS, Medicaid, HIPAA), documentation standards ...
... with a focus on chart audits, service documentation, provider billing practices, and care ... CMS, Texas Medicaid, and other applicable guidelines). Essential Functions * Conducts risk-based ...
... with a focus on chart audits, service documentation, provider billing practices, and care ... CMS, Texas Medicaid, and other applicable guidelines). Essential Functions * Conducts risk-based ...
Coding Educator & Auditor
Omaha, NE · On-site
$26 - $29.75/hr
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we ... Reviews CMS mandates and updates coding directives as needed. * Reviews Federal Register to ensure ...
Coding Educator & Auditor
Omaha, NE · On-site
$26 - $29.75/hr
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we ... Reviews CMS mandates and updates coding directives as needed. * Reviews Federal Register to ensure ...
Cms Focus Auditor information
See salary details
$41.5K - $49.1K
7% of jobs
$49.1K - $56.7K
13% of jobs
$58.8K is the 25th percentile. Wages below this are outliers.
$56.7K - $64.3K
18% of jobs
The median wage is $71.5K / yr.
$64.3K - $71.9K
13% of jobs
$71.9K - $79.5K
12% of jobs
$79.5K - $87K
13% of jobs
$87.3K is the 75th percentile. Wages above this are outliers.
$87K - $94.6K
9% of jobs
$94.6K - $102.2K
3% of jobs
$102.2K - $109.8K
5% of jobs
$109.8K - $117.4K
6% of jobs
$117.4K - $125K
1% of jobs
$41.5K
$78.2K
$125K
How much do cms focus auditor jobs pay per year?
As of Sep 13, 2026, the average yearly pay for cms focus auditor in the United States is $78,163.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,500.00 and $89,500.00 per year, depending on experience, location, and employer.
What are popular job titles related to Cms Focus Auditor jobs?
For Cms Focus Auditor jobs, the most frequently searched job titles are:
Claims Quality Auditor
Remote
HealthEdge
• Computer and Computer Peripheral Equipment and Software Wholesalers • 201 - 500 employees201 - 500 employees
Full-time
Posted 11 days ago
Job description
Overview
HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations that helps our customers achieve affordable, equitable health care for all. We have a strong global presence, with a workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.
You Are
UST HealthProof is looking for a Claims Quality Auditor with health plan claims administration operations experience, ideally within Medicaid managed care. This role will report to the Lead Auditor or Quality Audit Manager. The Quality Auditor performs audits of an assigned group of transactions (claims, enrollment, premium billing, paper claims and correspondence scanning) across Medicaid managed care, managed long-term care (MLTC), and dual-eligible (Medicare-Medicaid) lines of business, and will interact with the client audit team and operational managers daily to report on audit findings, which have an impact on production and quality. This role requires the ability to work both independently with limited supervision and collaboratively in a team environment.
The Opportunity
What You Need
Geographic Responsibility: Remote, US
Type of Employment: Full-time, permanent
Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:
The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.
HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.
#LI-Remote
**The annual US base salary range for this position is $44,000 to $50,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.
HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations that helps our customers achieve affordable, equitable health care for all. We have a strong global presence, with a workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.
You Are
UST HealthProof is looking for a Claims Quality Auditor with health plan claims administration operations experience, ideally within Medicaid managed care. This role will report to the Lead Auditor or Quality Audit Manager. The Quality Auditor performs audits of an assigned group of transactions (claims, enrollment, premium billing, paper claims and correspondence scanning) across Medicaid managed care, managed long-term care (MLTC), and dual-eligible (Medicare-Medicaid) lines of business, and will interact with the client audit team and operational managers daily to report on audit findings, which have an impact on production and quality. This role requires the ability to work both independently with limited supervision and collaboratively in a team environment.
The Opportunity
- Perform audits of Medicaid managed care and managed long-term care (MLTC) claims transactions processed by health plan administration associates for a specific customer.
- Be responsible for following the customer quality process and tools for audit and rebuttal process.
- Audit claims for long-term services and supports (LTSS), including home care, personal care, and other community-based service claim types, for accuracy and compliance with plan and regulatory requirements.
- Audit claims involving dual-eligible (Medicare-Medicaid) members to confirm accurate coordination of benefits and correct payer sequencing.
- Share QA results with individual associates, coordinate with operational Team Leads and managers to provide feedback to individuals, clearly identifying errors and opportunities of improvement.
- Collate, compile and report both team and individual associates' QA performance to management and individuals.
- Provide inputs to Training team and Team Leads for up-to-date written processing instruction/refresher training needs.
- Participate in UST HealthProof's or the customer's Audit the Auditor program.
- Participate in semi-annual or annual auditor calibration activities.
- Maintain currency on CMS and state Medicaid managed care claims processing rules, including guidelines for managed long-term care (MLTC) plans and dual-eligible integrated plans (D-SNP/MAP).
What You Need
- High School Diploma or GED required.
- 3 years health plan claims auditing operations experience required.
- Medicaid managed care claims auditing experience required; managed long-term care (MLTC) or dual-eligible (Medicare-Medicaid) claims auditing experience strongly preferred.
- Proficiency in using MS Suite, specifically Excel, PowerPoint and Outlook.
- HealthRules® Payor or GuidingCare® experience preferred.
- Ability to analyze contractual SLAs and KPIs.
- Ability to effectively communicate and collaborate with a remote team.
Geographic Responsibility: Remote, US
Type of Employment: Full-time, permanent
Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:
- The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
- Work across multiple time zones in a hybrid or remote work environment.
- Long periods of time sitting and/or standing in front of a computer using video technology.
- May require travel dependent on company needs.
The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.
HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.
#LI-Remote
**The annual US base salary range for this position is $44,000 to $50,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.
About HealthEdge
Sourced by ZipRecruiter
Health Edge ® provides modern, disruptive technology that delivers for the first time, a suite of products that enables healthcare payors to leverage new business models, improve outcomes, drastically reduce administrative costs and connect everyone in the healthcare delivery cycle. Our next-generation enterprise product suite, HealthRules ®, is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or on-site deployment. An award-winning company, HealthEdge empowers payors to capitalize on the innovations, challenges and opportunities that await in the new healthcare economy. For more information, visit .
Industry
Computer and computer peripheral equipment and software wholesalers
Company size
201 - 500 Employees
Headquarters location
Burlington, MA, US
Year founded
2005