... RAC-CTA) preferred. * Certified in Healthcare Compliance (must be obtained within one year of hire). Experience * 4 to 7 years of experience in Medicaid, Medicare, & Managed Care ADRs, Audits ...
... RAC-CTA) preferred. * Certified in Healthcare Compliance (must be obtained within one year of hire). Experience * 4 to 7 years of experience in Medicaid, Medicare, & Managed Care ADRs, Audits ...
Corporate Compliance Clinical Auditor
Westfield, IN · On-site +1
... RAC-CTA) preferred. * Certified in Healthcare Compliance (must be obtained within one year of hire). Experience * 4 to 7 years of experience in Medicaid, Medicare, & Managed Care ADRs, Audits ...
Quick apply
Corporate Compliance Clinical Auditor
Westfield, IN · On-site +1
... RAC-CTA) preferred. * Certified in Healthcare Compliance (must be obtained within one year of hire). Experience * 4 to 7 years of experience in Medicaid, Medicare, & Managed Care ADRs, Audits ...
Reimbursement Manager
$96K - $145K/yr
... audit contractor (RAC) reserves. * Federal Register Monitoring: Track and analyze ongoing changes ... in Medicare/Medicaid cost reporting · 3+ years experience in supervisory role · Proficient in ...
Quick apply
Reimbursement Manager
$96K - $145K/yr
... audit contractor (RAC) reserves. * Federal Register Monitoring: Track and analyze ongoing changes ... in Medicare/Medicaid cost reporting · 3+ years experience in supervisory role · Proficient in ...
Maintains system for monitoring and completing Medicare Certification/ Recertification for ... Staying current on trends related to medical necessity, DRG and Recovery Audit Contractor (RAC)
Maintains system for monitoring and completing Medicare Certification/ Recertification for ... Staying current on trends related to medical necessity, DRG and Recovery Audit Contractor (RAC)
W/Alt UM Nurse (BHS)
Granger, IN · On-site
Maintains system for monitoring and completing Medicare Certification/ Recertification for ... Staying current on trends related to medical necessity, DRG and Recovery Audit Contractor (RAC)
W/Alt UM Nurse (BHS)
Granger, IN · On-site
Maintains system for monitoring and completing Medicare Certification/ Recertification for ... Staying current on trends related to medical necessity, DRG and Recovery Audit Contractor (RAC)
Medicare Rac Audit information
See Indiana salary details
$12.12 - $13.64
4% of jobs
$13.64 - $15.16
7% of jobs
$16.50 is the 25th percentile. Wages below this are outliers.
$15.16 - $16.68
15% of jobs
$16.68 - $18.20
19% of jobs
The median wage is $18.60 / hr.
$18.20 - $19.71
18% of jobs
$19.71 - $21.23
9% of jobs
$21.65 is the 75th percentile. Wages above this are outliers.
$21.23 - $22.75
10% of jobs
$22.75 - $24.27
6% of jobs
$24.27 - $25.79
3% of jobs
$25.79 - $27.30
3% of jobs
$27.30 - $28.82
5% of jobs
$12
$19
$28
How much do medicare rac audit jobs pay per hour?
What are the key skills and qualifications needed to thrive in the Medicare Rac Audit position, and why are they important?
To excel in a Medicare RAC Audit role, you need a thorough understanding of Medicare regulations, auditing practices, and healthcare compliance, often supported by credentials such as a Certified Professional Medical Auditor (CPMA) or similar. Familiarity with audit management software, electronic health records (EHRs), and data analysis tools is commonly required. Attention to detail, analytical thinking, and clear written and verbal communication are important soft skills for producing accurate audit findings and interacting with providers. These skills ensure the identification of improper payments, maintenance of compliance, and support for healthcare organizations in navigating complex Medicare requirements.
What is a Medicare RAC Audit job?
A Medicare RAC (Recovery Audit Contractor) Audit job involves reviewing Medicare claims to identify and recover improper payments made to healthcare providers. RAC auditors analyze medical records, billing data, and coding practices to ensure compliance with Medicare guidelines. They work to detect overpayments and underpayments, helping to prevent fraud, waste, and abuse in the Medicare system. This role requires knowledge of medical coding, billing regulations, and healthcare compliance.
What are the typical daily responsibilities for someone working in Medicare RAC Audit?
Professionals in Medicare RAC Audit roles are primarily responsible for reviewing medical records and claims to identify and report improper payments or billing errors under Medicare guidelines. On a daily basis, you may analyze complex data, prepare detailed audit reports, communicate findings with healthcare providers, and collaborate with other compliance or billing team members to ensure corrections are implemented. The work often involves balancing independent research with collaborative meetings to resolve issues and maintain compliance. This position offers a fast-paced environment that requires strong organizational skills and provides significant exposure to Medicare policies and healthcare operations.

Full-time
Re-posted 7 days ago
Majestic Care rating
5.3
Based on 42 frontline employees who took The Breakroom Quiz
189th of 239 rated social care providers
Job description
Remote or Hybrid with travel as needed.
Our mission: Through the hearts of our Care Team Members, we provide excellent healthcare to those we serve.
Our Core Values...
L - Listening
E - Empathy
A - Accountability
D - Decisiveness
This is how we create a culture to LEAD with Love.
Through the hearts and minds of our care team members, we provide excellent healthcare to those we serve. With a vision of innovating healthcare by keeping those we serve at the heart of our mission, we provide tools, processes, support resources, data analytics, and insource strategies that drive results.
Position Overview:
Through the hearts and minds of our care team members, we provide excellent healthcare to those we serve. With a vision of innovating healthcare by keeping those we serve at the heart of our mission, we provide tools, processes, support resources, data analytics, and insource strategies that drive results.
The Corporate Compliance Clinical Audit Specialist is a key member of the Corporate Compliance & Ethics team. This position audits post-acute care facilities to assess adherence to the Office of Inspector General's (OIG) compliance program requirements for skilled nursing facilities, home health, and hospice. The role involves conducting facility reviews, identifying compliance gaps, and supporting the implementation of best practices aligned with industry standards and organizational policies.
Key Responsibilities:
Compliance Auditing and Oversight
- Conduct retrospective, concurrent, and prospective audits of medical records across skilled nursing, home health, and hospice settings to assess compliance with billing, coding, documentation, and quality standards.
- Identify discrepancies, errors, or potential non-compliance with federal/state regulations, payer requirements, and internal policies.
- Lead and manage internal compliance audits, ensuring timely completion, accurate documentation, and development of corrective action plans.
- Track audit outcomes and collaborate with stakeholders to implement monitoring strategies that support sustained compliance.
Audit Response and Denials Support
- Support pre- and post-payment audit responses by coordinating documentation, tracking deadlines, and communicating with payers as directed.
- Collaborate with clinical, billing, and operational teams to gather required documentation.
- Assist in managing denial responses, including gathering supporting documentation and contributing to appeal strategies.
- Coordinate responses to external audit requests and ensure timely, accurate submissions.
Training and Education
- Deliver post-audit training sessions tailored to audit findings, focusing on documentation, coding, billing, and regulatory compliance.
- Develop and present educational materials to care team members on compliance best practices and regulatory updates.
Investigations and Policy Development
- Participate in investigations of potential compliance concerns and evaluate opportunities for proactive auditing.
- Contribute to the review and enhancement of organizational policies and procedures to improve complianceand operational efficiency
Collaboration and Reporting
- Prepare and present audit and investigation findings to leadership, including recommendations for corrective actions and process improvements.
- Collaborate with departments such as Legal, Clinical, IT, Finance, MDS/RAI, Operations, and HR to address compliance issues and implement solutions.
- Maintain accurate records of audit activities and ensure alignment with HIPAA and regulatory standards.
Regulatory Awareness and Support
- Stay informed on changes in CMS, Managed Care, and other regulatory agency guidelines.
- Provide support for compliance initiatives and special projects as needed across the organization
Education
- Bachelor's degree required; equivalent work experience may be considered.
Licenses and Certifications
- Active clinical license (RN, LPN, PT/OT/ST, etc)
- Certifications (RAC-CT, RAC-CTA) preferred.
- Certified in Healthcare Compliance (must be obtained within one year of hire).
Experience
- 4 to 7 years of experience in Medicaid, Medicare, & Managed Care ADRs, Audits, & Denials.
- Compliance/Healthcare post-acute care experience, including billing, coding, and documentation
- Experience with Medicare A/B, Medicare Advantage, and Medicaid (multi-state) coverage criteria, Medicare billing rules, along with documentation standards.
- Proficiency with electronic health records (PCC) and healthcare documentation systems
- RN Preferred
Knowledge, Skills, and Abilities
- Strong understanding of healthcare regulations, compliance standards, and audit processes
- Strong knowledge of MDS, PDPM, and documentation requirements.
- Excellent analytical and problem-solving skills with attention to detail and accuracy
- Effective communication and interpersonal skills across multidisciplinary teams
- Ability to work independently and collaboratively in a fast-paced environment
- Skilled in managing multiple priorities and meeting deadlines with minimal supervision
- Strong organizational, planning, and project management abilities
- Ability to build and maintain professional relationships across departments
- High level of discretion and ability to handle sensitive and confidential information
- Expert-level proficiency in Microsoft Office 365 Suite (Teams, SharePoint, Excel, etc.)
- Demonstrated ability to remain composed and effective in high-pressure situations
- Proactive, resourceful, and solutions-oriented with a focus on continuous improvement
#Mcare
What Majestic Care employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Majestic Care
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Westfield, IN, US
Year founded
2018