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Medicare Audit Jobs (NOW HIRING)

Stance Health Solutions

MEDICARE SPECIALIST SUPERVISOR

$82K - $100K/yr

Conduct quality audits of completed orders and team workflows to identify gaps and ensure audit ... Support Medicare audits, Additional Documentation Requests (ADRs), Targeted Probe and Educate (TPE ...

PharMerica

Medicare B Specialist

Louisville, KY · On-site +1

Responds to Medicare payer audits * Maintains a thorough knowledge of Medicare coverage criteria, billing, coding, and documentation requirements Qualifications * High School Diploma or GED;

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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 Aug 6, 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?

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 Medicare auditor?

To become a Medicare auditor, candidates typically need a background in healthcare, accounting, or auditing, along with knowledge of Medicare policies and regulations. Relevant certifications such as Certified Healthcare Auditor (CHA) or Certified Public Accountant (CPA) can enhance prospects. Experience with medical billing, coding, or compliance is also valuable in this role.

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.

How do I become a Medicare audit?

To become a Medicare auditor, typically you need a background in healthcare, accounting, or auditing, along with relevant certifications such as CPA or Certified Healthcare Auditor. Gaining experience in healthcare billing, coding, or compliance is also important, and familiarity with Medicare regulations and audit tools can enhance your qualifications.

Is medical auditing a good career?

Medical auditing is a growing field that involves reviewing healthcare claims and medical records to ensure compliance and accuracy. It requires attention to detail, knowledge of healthcare regulations, and often certification, making it a stable career option with opportunities for advancement. The job typically involves working in healthcare or insurance environments and may require familiarity with auditing tools and software.
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 August 2026, with employment types broken down into 90% Full Time, 5% Part Time, 1% Temporary, and 4% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $71,776 per year, or $34.5 per hour.

MEDICARE SPECIALIST (Medicare Billing)

Stance Health Solutions

La Crescenta, CA • On-site

$23.67 - $29.77/hr

Full-time

Re-posted 4 days ago

Job description

Description:

Position Overview

This position collaborates with global and domestic cross-functional teams (order to cash), including Intake, Customer Care, and Billing, to resolve patient questions, concerns, and issues related to Medicare coverage, claims, denials, and patient responsibility. Responsibilities include inbound and outbound calls, insurance verification & payer change, invoice review, appeals and denial resolution, payment processing, and interpretation of claims and EOBs, all within a compliant, audit-ready framework.

This position operates in a call queue environment and serves as the primary point of contact for inbound patient billing inquiries within the Revenue Cycle Management (RCM) team, with a strong focus on Medicare-related billing, eligibility, and claims resolution. The role is responsible for delivering a high level of patient support while ensuring compliance with Medicare guidelines, CMS requirements, and DMEPOS billing standards.


Key Responsibilities

  • Handle high-volume inbound and outbound calls related to Medicare billing statements, coverage, payment plans, and coordination of benefits (COB)
  • Accurately document all patient interactions, including inquiries, complaints, and resolutions, ensuring compliance with Medicare and internal documentation standards
  • Interpret EOBs and explain Medicare patient responsibility, coverage limitations, and claim outcomes
  • Verify insurance eligibility, benefits, and coverage through payer portals, with a focus on Medicare qualification and active coverage
  • Review and recalculate invoices as needed to ensure alignment with Medicare billing rules and reimbursement guidelines
  • Manage and resolve denials and appeals, ensuring proper documentation and adherence to Medicare requirements for medical necessity and claims processing including Medicare audits.
  • Request and validate clinical documentation, prescriptions, and supporting records required to meet Medicare medical necessity standards
  • Identify and document compliance or non-compliance with treatment requirements, as applicable to Medicare coverage criteria
  • Coordinate with internal teams to ensure claims are clean, accurate, and ready for submission or resubmission
  • Respond to patient communications across multiple channels, including phone, email, portal, and fax
  • Route complex issues to appropriate teams while maintaining ownership of resolution
  • Ensure adherence to HIPAA, confidentiality, and Medicare compliance requirements at all times
  • Follow up on open tasks, worklists, and outstanding issues in a timely manner
  • Support equipment recovery processes when treatment ends or Medicare benefits terminate
  • Maintain knowledge of Medicare billing, reimbursement guidelines, and DMEPOS requirements
  • Identify trends and escalate training or process improvement opportunities
  • Perform other duties and special projects as assigned
  • Developing standard operating procedures for Medicare Order-to Cash.

Qualifications

  • Minimum of 2 years of customer service experience, preferably in a role emphasizing ownership of the customer or patient financial experience
  • Minimum of 2 year of experience in healthcare, with extensive expertise to Medicare billing, RCM, or DMEPOS environments preferred
  • Understanding of healthcare terminology, with working knowledge of Medicare claims, EOBs, and patient responsibility
  • Strong customer service, problem-solving, and critical thinking skills, with the ability to navigate Medicare-related billing and coverage questions
  • Ability to manage high-volume inbound calls and communications while maintaining accuracy and compliance
  • Strong verbal and written communication skills, with the ability to explain Medicare billing, coverage, and denials in a clear and professional manner
  • High attention to detail, with the ability to identify and correct errors related to claims, documentation, and billing accuracy
  • Ability to multitask, prioritize, and follow through in a fast-paced, metrics-driven environment
  • Self-starter with the ability to work independently and collaboratively across teams
  • Flexible and adaptable to changing business needs, particularly in a growing Medicare-focused operation
  • Proficiency in billing systems and Microsoft Office 365; experience with Brightree or similar DME billing platforms preferred
Requirements: