ZipRecruiter

Log In

1

Medicare Auditor Jobs in Riverside, CA (NOW HIRING)

Jobtailor

Senior Tax Analyst

Orange, CA · On-site

$140 - $190/hr

Support external tax advisors and auditors with documentation and analysis * Prepare and review ... Support data requests related to Medicare Advantage operations, regulatory filings, enrollment ...

Astiva Health

Enrollment Coordinator (Temp)

Orange, CA · On-site

$22 - $24/hr

Conducting daily enrollment process based on Medicare regulations and guidelines. * Responsible for entering and auditing enrollment applications into the member system and ensuring that each ...

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 ...

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 ...

next page

Showing results 1-20

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 25, 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.

How much do Medicare auditors make in the US?

Medicare auditors in the US typically earn between $50,000 and $80,000 annually, with experienced professionals or those in senior roles earning higher salaries. Compensation can vary based on location, experience, and certifications such as the Certified Professional Coder (CPC) or Certified Medical Auditor (CMA).
More about Medicare Auditor jobs

What are popular job titles related to Medicare Auditor jobs in Riverside, CA?

For Medicare Auditor jobs in Riverside, CA, the most frequently searched job titles are:

What job categories do people searching Medicare Auditor jobs in Riverside, CA look for?

The top searched job categories for Medicare Auditor jobs in Riverside, CA are:

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

Cities near Riverside, CA with the most Medicare Auditor job openings:

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, 76% Full Time, 17% 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.

Quality Control Auditor

San Bernardino, CA

LSMA Management Inc
See more jobs at LSMA Management Incexternal

$28.85 - $33.65/hr

Full-time

Re-posted 5 days ago

Job description

Description

JOB SUMMARY


The Quality Control Auditor - Claims Management is responsible for performing detailed audits of claims processing activities to ensure accuracy, regulatory compliance, and adherence to contractual, coding, and reimbursement requirements within the Managed Services Organization (MSO). This role evaluates claims adjudication performed by Claims Examiners, identifies errors, analyzes trends, and provides recommendations to improve claims accuracy, operational efficiency, and compliance with federal and California regulatory standards.

The Quality Control Auditor supports delegated managed care compliance by auditing claims in accordance with health plan contracts, coding standards, reimbursement methodologies, and applicable regulatory requirements, including Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), and Department of Health Care Services (DHCS) standards where applicable.

This role plays a critical role in maintaining claims processing integrity, minimizing financial risk, ensuring regulatory compliance, and supporting continuous operational improvement.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS


Education/Training

Minimum: High School Diploma or equivalent.

Preferred: Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Compliance, or related field.

Experience 

Minimum: At least five years of managed care claims auditing, claims examiner, or claims quality control experience. Two years of experience as a Claims   Examiner or Claims Adjuster. 

Preferred: Experience in MSO, IPA, or health plan environment. Experience supporting delegated managed care and regulatory audits. Experience auditing   professional and institutional claims.

Certification(s)

Preferred: Certified Professional Coder (CPC), Certified   Professional Medical Auditor (CPMA), or Certified Professional Compliance Officer (CPCO)


Skills, Knowledge & Abilities

Strong knowledge of managed care claims processing and audit methodologies.

Knowledge of CPT, HCPCS, ICD-10, DRG, and reimbursement methodologies. 

Knowledge of health plan contracts, fee schedules, and DOFR agreements. 

Knowledge of DMHC, CMS, DHCS, and regulatory requirements.

Strong analytical and problem-solving skills.

Ability to interpret and apply complex regulatory and contractual requirements.

Strong attention to detail and audit documentation skills.

Excellent written and verbal communication skills. 

Proficiency with claims systems such as EZ Cap and Microsoft Office applications. 

Ability to work independently and meet audit   deadlines.

Ability to maintain confidentiality and data integrity.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and involves prolonged periods of sitting, computer use, and document review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure claims accuracy and regulatory compliance. Light physical effort may be required, including lifting up to approximately 10 pounds and occasional bending, reaching, or filing. This role requires the ability to maintain confidentiality and professionalism when handling sensitive claims and compliance information.


PAY RANGE

$28.85 - $33.65 / hourly

Apply