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Medical Compliance Auditor Jobs (NOW HIRING)

Merakey

Compliance Auditor

Lafayette Hill, PA · On-site

$26.72 - $29.26/hr

We are seeking a Compliance Auditor to join our team. This is a remote position with 25% travel ... Comprehensive medical, dental, and vision coverage, plus access to healthcare advocacy support.

St. Joseph's/Candler

Compliance Auditor

Savannah, GA · On-site

$25.49/hr

The Compliance Auditor will support the compliance functions at SJ/C. The auditor is expected to ... Knowledge of medical terminology, ICD-10, CPT, HCPCs, DRG, APC, ICD-10 PCS modifiers, billing ...

St. Joseph's/Candler

Compliance Auditor

Savannah, GA

$25.49/hr

The Compliance Auditor will support the compliance functions at SJ/C. The auditor is expected to ... Knowledge of medical terminology, ICD-10, CPT, HCPCs, DRG, APC, ICD-10 PCS modifiers, billing ...

St. Joseph's/Candler

Compliance Auditor

Savannah, GA · On-site

$25.49/hr

The Compliance Auditor will support the compliance functions at SJ/C. The auditor is expected to ... Knowledge of medical terminology, ICD-10, CPT, HCPCs, DRG, APC, ICD-10 PCS modifiers, billing ...

NHC HomeCare - Quincy

Compliance Auditor

Quincy, FL · On-site

Definition: The Medicare Compliance Auditor reports to the Director of Clinical Education and ... Perform detailed audits of documents, including medical records, to ensure compliance to government ...

Covenant Health

COMPLIANCE AUDITOR

Knoxville, TN · On-site +1

Overview Compliance Auditor Full Time, 80 Per Hour Pay Period, Day Shift This position is Remote ... Medical Group, our area's fastest-growing physician practice division. Headquartered in Knoxville ...

NHC HomeCare - Chipley

Compliance Auditor

Chipley, FL · On-site

Definition: The Medicare Compliance Auditor reports to the Director of Clinical Education and ... Perform detailed audits of documents, including medical records, to ensure compliance to government ...

State of South Carolina

Compliance Auditor

Columbia, SC · On-site +1

$58K - $105K/yr

You will encourage taxpayer compliance by educating taxpayers and conducting operational, financial ... medical conditions, including, but not limited to, lactation. Hours: Flexible hours may be ...

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Medical Compliance Auditor information

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$31.5K

$68.7K

$112K

How much do medical compliance auditor jobs pay per year?

As of Aug 26, 2026, the average yearly pay for medical compliance auditor in the United States is $68,732.00, according to ZipRecruiter salary data. Most workers in this role earn between $49,000.00 and $86,500.00 per year, depending on experience, location, and employer.

What does a medical compliance auditor do?

A Medical Compliance Auditor is responsible for ensuring that healthcare organizations adhere to regulatory requirements, internal policies, and industry standards. They review medical records, billing processes, and operational procedures to identify areas of non-compliance and recommend corrective actions. Their work helps prevent fraud, reduce risk, and maintain the integrity of healthcare delivery. Often, they also conduct staff training on compliance matters and assist in preparing for external audits.

What are some common challenges faced by medical compliance auditors when working with healthcare providers?

Medical Compliance Auditors often encounter challenges such as navigating complex and evolving healthcare regulations, ensuring accurate documentation, and fostering cooperation from clinical and administrative staff during audits. Building trust and communicating the importance of compliance can be demanding, especially when providers are apprehensive about the auditing process. Additionally, auditors must stay current on regulatory changes and be prepared to educate teams on best practices, making adaptability and strong interpersonal skills essential for success.

What are the key skills and qualifications needed to thrive as a medical compliance auditor, and why are they important?

To thrive as a Medical Compliance Auditor, you need a solid understanding of healthcare regulations, coding standards, and auditing procedures, often supported by a degree in healthcare or a related field and certifications such as Certified Professional Medical Auditor (CPMA). Familiarity with electronic health record (EHR) systems, auditing software, and compliance management tools is typically required. Attention to detail, analytical thinking, and strong communication skills are vital soft skills for ensuring accuracy and effective reporting. These competencies are crucial for identifying compliance risks, maintaining regulatory standards, and protecting healthcare organizations from legal and financial penalties.

What is the difference between Medical Compliance Auditor vs Medical Compliance Specialist?

AspectMedical Compliance AuditorMedical Compliance Specialist
CertificationsOften requires Certified Compliance & Ethics Professional (CCEP) or similarTypically holds Certified Medical Compliance Professional (CMCP) or similar
Work EnvironmentAuditing healthcare facilities, reviewing records, ensuring regulatory adherenceDeveloping compliance programs, training staff, monitoring policies
Employer & Industry UsageHospitals, clinics, healthcare organizationsHealthcare providers, insurance companies, healthcare consulting firms

The Medical Compliance Auditor primarily reviews records and ensures regulatory adherence through audits, while the Medical Compliance Specialist focuses on developing compliance programs and training staff. Both roles require similar certifications and work within healthcare settings, but their core responsibilities differ in focus and daily tasks.

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What cities are hiring for Medical Compliance Auditor jobs?

Cities with the most Medical Compliance Auditor job openings:

What states have the most Medical Compliance Auditor jobs?

States with the most job openings for Medical Compliance Auditor jobs include:

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The top searched job categories for Medical Compliance Auditor jobs are:

Medical Compliance Auditor jobs near you
Infographic showing various Medical Compliance Auditor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $68,732 per year, or $33 per hour.

Medical Compliance Auditor

Texas Children's Hospital

Bellaire, TX • On-site

Full-time

Re-posted 6 days ago

Texas Children's Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 177 frontline employees who took The Breakroom Quiz

86th of 1,064 rated hospitals

Job description

We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria.

Think you've got what it takes?

Job Duties & Responsibilities 
   Assess the treatment plan, clinical information, and medical necessity of all requested services 
   Utilizes established criteria to appropriately review billed services within established timeframe required. 
   Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. 
   Refers case failing medical necessity criteria to the Special Investigations Unit (SIU) Director and SIU Workgroup for review and a recommendation for action. 
   Telephonic follow-up with the provider's office to request additional information as needed. 
   Completes timely entry of information into electronic file including a chart with detailed findings of the review and a report summarizing the results of the audit. 
   Evaluate benefit coverage and regulatory guidelines pertinent to decision making for each investigation. 
   Perform Clinical and Coding Review on Medical Claim Appeals. 
   Assess and process all education and recoupment letters after Special Investigative Committee review decision. 
   Facilitates provider communication and education. 
   Liaisons with internal staff members. 
   Perform Clinical Review and make recommendation on Audit Pass/Fail. 
   Ongoing assessment for quality indicators and concerns.


Skills & Requirements 
    Required Associate's Degree in Nursing  or
    Technical Diploma in Vocation Nursing
    Preferred Bachelor's Degree in Nursing
    Required LVN - Lic- Licensed Vocational Nurses Texas Board of Nursing or Nursing Licensure Compact or 
    RN-Lic-Registered Nurses Texas Board of Nursing or Nursing Licensure Compact 
    Preferred CPC-Cert-Cert Professional Coder Americal Academy of Professional Coders
     Required 3 years Clinical experience in the applicable field according to the license (LVN or RN) 
     4 years of Medical Auditing experience.
 

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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