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Medicare Audit information

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$25K

$71.8K

$108K

How much do medicare audit jobs pay per year?

As of Jun 13, 2026, the average yearly pay for medicare audit in the United States is $71,776.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,500.00 and $81,500.00 per year, depending on experience, location, and employer.

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

To thrive as a Medicare Auditor, you need a strong background in healthcare compliance, auditing principles, and knowledge of Medicare regulations, typically supported by a degree in health administration, accounting, or a related field. Familiarity with audit software, claims processing systems, and certifications such as Certified Professional Medical Auditor (CPMA) or Certified Internal Auditor (CIA) are often required. Attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and explain findings effectively. These skills ensure accurate assessments, minimize compliance risks, and safeguard organizations from financial penalties.

How to become a medical insurance auditor?

To become a medical insurance auditor, candidates typically need a background in healthcare, accounting, or related fields, along with knowledge of insurance policies and billing practices. Earning certifications such as the Certified Professional Medical Auditor (CPMA) or similar credentials can enhance job prospects. Experience with medical records, coding, and auditing software is also valuable in this role.

Is an auditor a high paying job?

Auditors, including those working in Medicare audits, can earn competitive salaries that vary based on experience, location, and certification level. Generally, senior auditors and those with specialized skills or certifications tend to have higher pay, but salaries may still be below top-tier executive roles. Entry-level auditors typically earn moderate wages compared to other finance or healthcare positions.

What is a Medicare auditor?

A Medicare auditor is a professional responsible for reviewing healthcare claims and medical records to ensure compliance with Medicare regulations and proper billing practices. They often work for government agencies or contracted organizations, using auditing tools and knowledge of healthcare policies to detect fraud, waste, or errors.

What are some common challenges faced by professionals working in Medicare Audit roles?

Professionals in Medicare Audit roles often encounter challenges such as keeping up with frequently changing regulations, interpreting complex billing codes, and ensuring compliance with strict federal guidelines. They must also navigate large volumes of medical records and documentation to identify errors, discrepancies, or potential fraud. Additionally, effective collaboration with healthcare providers and internal compliance teams is crucial to resolve identified issues and implement corrective actions.

What is a Medicare Audit?

A Medicare audit is a review process conducted by the Centers for Medicare & Medicaid Services (CMS) or its contractors to ensure that healthcare providers are complying with Medicare billing requirements and regulations. These audits check for billing accuracy, medical necessity of services, and adherence to documentation standards. The goal is to detect and prevent improper payments, fraud, and abuse within the Medicare program. Providers who are audited may need to submit medical records and other documents for review, and they could face repayments or penalties if errors are found.

What is the difference between Medicare Audit vs Medicare Billing Specialist?

AspectMedicare AuditMedicare Billing Specialist
CredentialsKnowledge of Medicare regulations, auditing certificationsMedical billing certifications, coding knowledge
Work EnvironmentHealthcare facilities, government agencies, consulting firmsMedical offices, billing companies, healthcare providers
Employer & Industry UsageUsed by healthcare auditors, government agencies, consulting firmsUsed by healthcare providers, billing companies, hospitals

Medicare Audit professionals focus on reviewing and verifying Medicare claims for accuracy and compliance, often working in healthcare or government settings. Medicare Billing Specialists handle the submission and management of Medicare claims, ensuring proper coding and billing practices. While both roles require knowledge of Medicare policies, audits are more analytical and compliance-driven, whereas billing specialists focus on claim processing and documentation.

Is it hard to become a medical auditor?

Becoming a Medicare medical auditor typically requires a background in healthcare, such as nursing, coding, or health administration, along with knowledge of medical billing and coding standards. Certification, like the Certified Professional Coder (CPC) or Certified Medical Auditor (CMA), can improve job prospects. The role often involves detailed review of medical records and claims, requiring attention to detail and familiarity with regulatory guidelines.
More about Medicare Audit jobs
What cities are hiring for Medicare Audit jobs? Cities with the most Medicare Audit job openings:
What states have the most Medicare Audit jobs? States with the most job openings for Medicare Audit jobs include:
What job categories do people searching Medicare Audit jobs look for? The top searched job categories for Medicare Audit jobs are:
Medicare Audit jobs near you
Infographic showing various Medicare Audit job openings in the United States as of June 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 83% In-person, and 17% Remote job distribution, with an average salary of $71,776 per year, or $34.5 per hour.
Provider Audit and Reimbursement Manager (CMS)

Provider Audit and Reimbursement Manager (CMS)

ARC Group

Jacksonville, FL • On-site, Remote

$96K - $126K/yr

Full-time

Posted 4 days ago

Job description

PROVIDER AUDIT AND REIMBURSEMENT MANAGER (CMS) - REMOTE
ARC Group has an immediate opportunity for a Provider Audit and Reimbursement Manager (CMS)! Must have experience with Medicare Cost Reports. This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization offering tremendous career growth potential.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization.
Job Description:
The Provider Audit and Reimbursement Manager is responsible for managing a team of auditors and ensuring the work is performed in compliance with the Medicare laws and regulations, the standards set forth by the Centers for Medicare and Medicaid Services (CMS), the company's and department's quality and production standards, and the company's policies and procedures. The Manager will be responsible for either audit or reimbursement functions and can be responsible for one of four primary roles -- desk review/audit, reopenings/appeals, interim rate review/reimbursement or acceptance/finalization for all provider types as both a preparer and reviewer of work product. The Manager assigns annual workload budget, distributes assignments to the team, ensures timely and accurate completion and review of all work, and makes final reimbursement determinations for all work assigned to the team.
ESSENTIAL DUTIES & RESPONSIBILITIES:
  • Manages team members and workload of the Audit/Reimbursement unit to ensure compliance with the standards set forth by CMS. The standards are in the form of Medicare laws and regulations and budget dollars granted for completion of the workload. (20%)
  • Manages the daily activities of the Audit/Reimbursement unit, coordinates their interactions with other departments and numerous external entities. Assigned team members can be in more than one office location. (20%)
  • Coordinates and manages the reimbursement for services, ensures that assigned team members update interim rates and other payment factors, ensures that all changes are entered into the claims processing system, and produces credible output reports that capture all relevant claim payment data required for cost report preparation and settlement. (5%)
  • Coordinates the testing and validation of the pricing software releases installed in the payment system. (5%)
  • Manages audits, provides direction to team members via work assignments, coordinates subordinate duties and provides guidance on audit issues. (5%)
  • Maintains and controls audit and appeal assignments, and also schedules resources to meet performance requirements. (5%)
  • Ensures that the Provider Audit unit completes its assigned objectives within the limits of established quality, policies, regulations and budgets. Determines the initial plan of audit work to be performed at desk and in the field for all assigned units. (5%)
  • Reviews workpapers of auditors for correctness, control and adherence to Generally Accepted Accounting Practices (GAAP), Generally Accepted Accounting Standards (GAAS) and Government Auditing Standards (GAS) as required. Examines and reviews workpapers upon completion of the audit to ensure compliance with CMS Uniform Desk Review (UDR), policy, or technical direction and reflects proper reference, clear and concise conclusion of the major audit categories and assembly of working papers into logical sequence. (5%)
  • Reviews, evaluates and approves the disbursement of tentative cost settlements in compliance with Federal Government regulations for each class/type of provider within area of responsibility. (5%)
  • Makes accounting decisions relative to audits, conferring, when necessary, with Senior Manager or Director on audit problems and/or interpretations of regulations. (5%)
  • Reviews completed audit reports and approves them prior to the Senior Manager's or Director's review. (5%)
  • Attends entrance and exit conferences, lends assistance to auditors as required, and follows up on audit recommendations. Reviews, researches and/or answers inquiries from governmental and other agencies regarding findings made on provider cost reports. (5%)
  • Researches and reviews all written policies as related to the interpretation and application of governmental regulations on a consistent basis as affecting cost settlements. (5%)
  • Attends meetings away from office as needed and renders assistance to providers by responding to inquiries. (5%)
REQUIRED QUALIFICATIONS
  • Bachelors'/Master's degree with a concentration/major in Accounting or Finance. Bachelor's/Master's degree in other fields can qualify if the candidate has 15 or more credit hours in specific Accounting or Finance classes.
  • 4 years' related work experience in Medicare audit and reimbursement, including 3 years supervisory/project management lead or other leadership experience.
  • Demonstrated oral and written communications skills
  • Demonstrated ability to exercise independent judgement and discretion
  • Demonstrated attention to detail
PREFERRED QUALIFICATIONS
* Masters in Business Administration (MBA)
* Certified Public Accountant (CPA)
This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available.
Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke johnb@arcgonline.com or apply online while viewing all of our open positions at www.arcgonline.com.
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.