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Medicare Auditor Jobs in Riverside, CA (NOW HIRING)

MCM & Associates LLC

Controller

Santa Ana, CA · Hybrid

Medicare regulations * CMS requirements * State licensing requirements * Corporate policies * Coordinate annual financial audits and tax reporting. * Serve as primary contact for external auditors ...

Alignment Healthcare

Sr. Tax Analyst

Orange, CA · On-site

$123K - $124K/yr

Together. Join a fast-growing, mission-driven Medicare Advantage health plan where your tax ... Coordinate with external tax advisors and auditors to support compliance activities. Own Tax ...

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All JobsMedicare Auditor JobsMedicare Auditor Jobs in Riverside, CA

Medicare Auditor information

See Riverside, CA salary details

$10

$20

$48

How much do medicare auditor jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for medicare auditor in Riverside, CA is $20.04, according to ZipRecruiter salary data. Most workers in this role earn between $15.05 and $20.05 per hour, depending on experience, location, and employer.

What does a Medicare auditor do?

A Medicare Auditor reviews and examines healthcare providers' billing and medical records to ensure compliance with Medicare regulations and policies. Their main goal is to identify improper payments, fraud, waste, or abuse within the Medicare system. Medicare Auditors analyze claims data, conduct interviews, and prepare detailed reports of their findings, which may result in recommendations for corrective actions or repayments. They play a crucial role in maintaining the integrity of the Medicare program and ensuring taxpayer funds are spent appropriately.

What does a Medicare auditor do?

As a Medicare auditor, you review health insurance information and documentation to ensure accuracy and locate errors or discrepancies. Your duties include reviewing billing and claims processes to ensure healthcare and medical service providers abide by Medicare regulations. Your responsibilities often involve investigating errors in billing, problems with Medicare eligibility determinations, and possible cases of fraud. Some auditors focus on medical coding accuracy. In these positions, you review medical records to ensure that medical codes match services provided, and you determine whether the services or treatments were medically necessary. Auditors also review processes and make recommendations to improve efficiency.

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 expertise in healthcare regulations, medical billing and coding, and a background in accounting or health information management, often supported by relevant certifications like RHIA, CPC, or CFE. Familiarity with audit software, electronic health records (EHRs), and Medicare claims processing systems is essential. Strong analytical thinking, attention to detail, and effective communication skills help auditors identify discrepancies and collaborate with healthcare providers. These skills ensure compliance with federal regulations, prevent fraud, and protect the integrity of Medicare funds.

What are some common challenges Medicare auditors face when reviewing healthcare provider documentation?

Medicare Auditors often encounter challenges such as incomplete or inconsistent medical records, varying documentation practices across providers, and frequent updates to Medicare regulations. Staying current with regulatory changes and interpreting complex billing codes require strong attention to detail and ongoing training. Additionally, auditors must communicate findings tactfully with providers to promote compliance while maintaining professional relationships.

What is the difference between Medicare Auditor vs Medicare Claims Reviewer?

AspectMedicare AuditorMedicare Claims Reviewer
Required CredentialsCertifications in auditing, healthcare compliance, or related fields; often CPA or CPC certificationsCertifications in medical coding, claims processing, or healthcare compliance; CPC certification common
Work EnvironmentTypically in healthcare facilities, government agencies, or insurance companies; focus on audits and complianceUsually in healthcare providers, insurance companies, or government agencies; focus on reviewing claims for accuracy
Employer & Industry UsageUsed by government agencies, insurance companies, and healthcare organizations for compliance auditsUsed by healthcare providers, insurance companies, and government programs for claims assessment

Medicare Auditors and Medicare Claims Reviewers both work within the healthcare industry and require knowledge of healthcare regulations. However, Medicare Auditors primarily focus on evaluating compliance and financial accuracy through audits, while Medicare Claims Reviewers assess individual claims for correctness before payment. Both roles are essential for maintaining Medicare program integrity but differ in their specific responsibilities and work environments.

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What cities near Riverside, CA are hiring for Medicare Auditor jobs?

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Medicare Auditor jobs near you
Infographic showing various Medicare Auditor job openings in Riverside, CA as of August 2026, with employment types broken down into 3% As Needed, 78% Full Time, 15% Part Time, and 4% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $41,675 per year, or $20 per hour.

MEDICARE COMPLIANCE PROGRAM LEAD

Stance Health Solutions

Irvine, CA • On-site, Remote

$94K - $118K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Job Type
Full-time
Description
Position Overview
The Medicare Compliance Program Lead serves as the primary subject matter expert for Medicare compliance operations, ensuring adherence to CMS regulations, DMEPOS requirements, and organizational standards. This role is responsible for developing and maintaining compliance processes, internal controls, and auditing systems to support intake, documentation, billing readiness, and regulatory requirements.
The position partners with Intake, Revenue Cycle Management (RCM), Customer Care, and Operations to improve documentation accuracy, eligibility verification, billing compliance, and reimbursement outcomes, while supporting scalable workflows and ongoing compliance oversight.
Key Responsibilities
  • Administer the Medicare compliance program, ensuring adherence to CMS regulations, Medicare guidelines, and DMEPOS standards
  • Audit Medicare-related operational processes, including intake documentation, qualification, re-certification, and billing readiness
  • Establish and monitor internal controls and auditing systems to identify compliance risks and operational gaps
  • Serve as the primary compliance liaison across Intake, RCM, Customer Care, and Operations to improve Medicare workflows and resolve compliance-related issues.
  • Conduct routine audits of patient documentation, billing readiness, and reimbursement processes to ensure regulatory compliance
  • Interpret new and revised Medicare regulations and implement process updates to maintain compliance
  • Develop and maintain compliance policies, procedures, and documentation standards
  • Lead training initiatives and provide ongoing guidance to staff on Medicare documentation requirements, eligibility criteria, and billing standards
  • Provide guidance related to audits, denials, and compliance concerns
  • Prepare and present compliance reports, audit findings, and risk assessments to leadership
  • Identify opportunities for operational improvement and support strategic initiatives related to Medicare growth and compliance scalability
  • Provide guidance, onboarding support, and subject matter expertise to new team members as the department expands
  • Perform other duties as assigned

Qualifications
  • Bachelor's degree preferred or equivalent combination of education and experience
  • Minimum 5 years of healthcare compliance experience, with strong Medicare, CMS, or DMEPOS experience required
  • Minimum 2 years of experience leading cross-functional compliance initiatives and operational workflows preferred
  • Strong knowledge of Medicare intake, billing, documentation requirements, and reimbursement processes
  • Demonstrated ability to interpret complex healthcare regulations and implement operationally effective solutions
  • Experience with internal auditing, compliance investigations, and corrective action planning
  • Advanced proficiency in Microsoft Office (Word, Excel, Outlook) and Adobe
  • Strong analytical, organizational, and problem-solving skills
  • Ability to manage multiple priorities in a fast-paced environment
  • Must be available to work evenings, weekends, and holidays if needed

Salary Description
$94616 - $118994

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