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Medicare Auditor Jobs (NOW HIRING)

MMC Group

DRG Auditor

San Antonio, TX · Remote

... Medicare, and Medicaid Clients. DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

Medicare Cost Reporting Auditor II

Nevada, IA · Hybrid

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

Ourhrconnect

$72K - $94K/yr

Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in ...

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Medicare Auditor information

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How much do medicare auditor jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for medicare auditor in the United States is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $14.42 and $19.23 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 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 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 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.

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.

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The top searched job categories for Medicare Auditor jobs are:

Medicare Auditor jobs near you
Infographic showing various Medicare Auditor job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 79% Full Time, 14% Part Time, and 3% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.

DRG Auditor

MMC Group

San Antonio, TX • Remote

Full-time

Re-posted 28 days ago

Job description


Job Description:

A leader in providing clinical auditing services to public and commercial healthcare payers throughout the US, has openings for remote DRG Validation Auditors. As members of the DRG Validation Team and working remotely, incumbents will be responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of various health plans, including Commercial, Medicare, and Medicaid Clients. DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. Initially, DRG Validation Auditors are prepared for the role through a detailed, well-defined training process, gaining knowledge and skills in methods for review of medical records and other provider documentation. Ongoing training and education are provided specific to audit processes, coding and reimbursement changes, and other topics as well. The DRG Validation Auditor reports to a DRG Validation Team Leader, who provides support, feedback, and guidance to DRG Validation Auditors. Moreover, quality assurance is provided through a well-defined review and quality management program performed by the Professional Development Team.


Specifically, DRG Validation Auditors will be responsible for the following:


  • Review inpatient medical records to validate the admit order, assignment and sequencing of ICD9-CM diagnosis and procedure codes, discharge status codes, and DRG assignment.

  • Provide a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.

  • Follow proper procedure for referral to Clinical Nurse Auditor or Physician Advisor.

  • Utilize proper reference material, standards, and guidelines for coding.

  • Provide input to the Edit Development team on claims selection criteria.

  • Verify data received from client and work to resolve discrepancies.

  • If the contract requires onsite review, interact with Providers and other personnel in a professional manner.

  • Follow policies and processes

  • Comply with department standards regarding productivity and audit quality.

  • Perform other duties as assigned.



To be considered for these challenging roles, applicants must have a majority of the following skills, knowledge and abilities:


  • Possess current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred

  • Demonstrate extensive knowledge of ICD-9-CM coding and DRG reimbursement, with a minimum of five years of inpatient coding experience

  • Have an understanding of Medicare, Medicaid, and commercial provider reimbursement methodologies, and possess strong data analysis skills

  • Working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems

  • Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure

  • Ability to adapt to changing priorities in order to meet Client requirements and productivity standards and deadlines

  • Ability to travel for additional training and on-site reviews on an as-needed basis

  • Since incumbents will work from their home-based offices, they must have their own access to high-speed Internet connectivity