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Managed Care Auditor Jobs (NOW HIRING)

Independent Living Systems

Claims Auditor

Miami, FL · On-site

By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery ...

Independent Living Systems

Claims Auditor

Miami, FL · On-site

By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery ...

WakeMed

Director, Managed Care Contracting

Raleigh, NC · On-site

When requested, interfaces with external and third party auditors; prepares and defends contract ... Or Healthcare Management Or Accounting Required - With College Courses Finance Required - And ...

Communicarehealth

Managed Care Biller

Blue Ash, OH · On-site

$17.50 - $22.50/hr

PURPOSE/BELIEF STATEMENT The position of Managed Care Biller/Collector is responsible for billing, receivables auditing, and collections activities for services provided to patients in the facilities ...

C2Q Health Solutions

COMPLIANCE AUDITOR

New York, NY · Hybrid

$90K - $100K/yr

As a Compliance Auditor, you'll help identify risks, strengthen internal controls, and support a ... Experience within a Health Plan, Managed Care Organization, PACE Program, or healthcare delivery ...

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Managed Care Auditor information

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$10

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$46

How much do managed care auditor jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for managed care auditor 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 Managed Care Auditor vs Claims Reviewer?

AspectManaged Care AuditorClaims Reviewer
Required CredentialsCertifications like CHC, CPC, or relevant healthcare auditing credentialsOften CPC, CCS, or claims processing certifications
Work EnvironmentHealthcare organizations, insurance companies, government agenciesInsurance companies, healthcare providers, third-party administrators
Employer & Industry UsageUsed in managed care plans, health insurance, and healthcare complianceCommon in insurance claims processing and reimbursement review

While both roles involve reviewing healthcare-related documents, Managed Care Auditors focus on evaluating the accuracy and compliance of managed care plans, whereas Claims Reviewers primarily assess individual insurance claims for correctness and eligibility. The roles often overlap in credentials and work environments but differ in scope and focus within the healthcare reimbursement process.

Is an auditor a high paying job?

Managed care auditors typically earn salaries that are competitive within the healthcare and insurance industries, with pay often increasing with experience, certifications, and specialized skills. While some auditors can earn high salaries, especially in senior or managerial roles, entry-level positions tend to have moderate pay compared to other healthcare professionals.

How do you become a healthcare auditor?

To become a healthcare auditor, typically one needs a bachelor's degree in health administration, accounting, or a related field, along with experience in healthcare or insurance. Certification such as the Certified Professional Coder (CPC) or Certified Healthcare Auditor (CHA) can enhance job prospects, and strong analytical skills are essential for reviewing medical records and claims. Many roles also require knowledge of healthcare regulations and auditing software.

What is a Managed Care Auditor?

A Managed Care Auditor is a professional who reviews and evaluates healthcare claims, billing records, and contracts to ensure compliance with managed care agreements and regulatory requirements. They work for insurance companies, healthcare providers, or third-party organizations to identify errors, prevent fraud, and ensure that reimbursements are accurate. Managed Care Auditors help organizations optimize their processes, reduce costs, and maintain compliance with healthcare laws and policies. Their work plays a crucial role in safeguarding the financial integrity of managed care programs.

What are some common challenges faced by Managed Care Auditors when working with healthcare providers and payers?

Managed Care Auditors often encounter challenges such as navigating complex contract terms, interpreting varying payer requirements, and keeping up with frequent regulatory changes. Coordinating with healthcare providers and insurance companies can also be demanding, as it requires strong communication and negotiation skills to resolve discrepancies. Additionally, Managed Care Auditors must maintain accuracy and attention to detail while analyzing large volumes of medical and financial data, all within tight deadlines.

What are the 3 C's of auditing?

The 3 C's of auditing are completeness, accuracy, and compliance. These principles help managed care auditors ensure that medical records and claims are thorough, correct, and adhere to regulations, which is essential for accurate reimbursement and quality assurance.

What kind of auditor makes the most money?

In the field of managed care auditing, senior auditors, compliance auditors, and those with specialized certifications such as Certified Professional Coder (CPC) or Certified Healthcare Auditor (CHA) tend to earn higher salaries. Auditors with extensive experience, advanced skills in data analysis, and leadership roles generally make the most money in this profession.

What are the key skills and qualifications needed to thrive as a Managed Care Auditor, and why are they important?

To thrive as a Managed Care Auditor, you need in-depth knowledge of healthcare compliance, claims auditing, and managed care regulations, often supported by a degree in healthcare administration or a related field. Familiarity with claims processing systems, medical coding software (such as ICD-10 and CPT), and audit management tools is typically required, with certifications like Certified Professional Medical Auditor (CPMA) being advantageous. Attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and collaborate with stakeholders. These skills are crucial for ensuring healthcare providers and payers adhere to regulatory standards and optimize financial performance.
More about Managed Care Auditor jobs
What cities are hiring for Managed Care Auditor jobs? Cities with the most Managed Care Auditor job openings:
What states have the most Managed Care Auditor jobs? States with the most job openings for Managed Care Auditor jobs include:
What job categories do people searching Managed Care Auditor jobs look for? The top searched job categories for Managed Care Auditor jobs are:
Managed Care Auditor jobs near you
Infographic showing various Managed Care Auditor job openings in the United States as of July 2026, with employment types broken down into 32% Locum Tenens, 61% Full Time, 5% Part Time, 1% Contract, and 1% Summer. Highlights an 87% Physical, 6% Hybrid, and 7% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.
Managed Care Compliance Specialist - Managed Care

Managed Care Compliance Specialist - Managed Care

Cedars Sinai

Beverly Hills, CA

Other

Posted 20 days ago

Cedars-Sinai rating

8.6

Company rating: 8.6 out of 10

Based on 130 frontline employees who took The Breakroom Quiz

41st of 1,051 rated hospitals

Job description

The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.

Duties and Responsibilities:
  • Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
  • Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
  • Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
  • Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
  • Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
  • Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
  • Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
  • Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
  • Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
  • Remains updated on all member and provider policy changes made by the health plan and/or the State.
  • Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
  • Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.Education:

High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.

Experience:

Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.

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