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Provider Auditor Jobs (NOW HIRING)

Mountain Area Health Education Center

The Provider Educator plays a key role in empowering our healthcare providers-physicians, residents ... Collaborates with our auditor to review audits, set up audit schedule and give feedback * Conducts ...

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Provider Auditor information

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$30.5K

$72.6K

$117.5K

How much do provider auditor jobs pay per year?

As of Aug 17, 2026, the average yearly pay for provider auditor in the United States is $72,633.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,000.00 and $98,500.00 per year, depending on experience, location, and employer.

What is a provider auditor?

Provider Auditors are professionals who review and assess healthcare providers’ records, billing practices, and claims to ensure compliance with regulations and detect potential fraud or errors. They analyze medical documentation, verify the accuracy of billing codes, and ensure that services billed were actually provided and are medically necessary. Provider Auditors play a crucial role in maintaining the integrity of healthcare reimbursement systems and help organizations avoid penalties associated with improper billing.

What skills and qualifications are needed to be a provider auditor?

To thrive as a Provider Auditor, you need a solid understanding of healthcare billing, coding standards (such as ICD-10 and CPT), and auditing procedures, often supported by a degree in healthcare administration or a related field. Familiarity with claims management software, electronic health records (EHR) systems, and certifications like Certified Professional Medical Auditor (CPMA) are commonly required. Attention to detail, analytical thinking, and strong communication skills help you identify discrepancies and clearly relay findings to providers. These skills ensure accurate audits, regulatory compliance, and reduced financial risk for healthcare organizations.

What challenges do provider auditors face when evaluating healthcare claims, and how can they address them?

Provider Auditors often encounter challenges such as incomplete documentation, complex billing codes, and discrepancies between services billed and services rendered. To address these, auditors need to maintain strong attention to detail, stay updated on current regulations and coding standards, and communicate effectively with providers to clarify ambiguities. Building collaborative relationships with clinical staff and regularly participating in training sessions can also help auditors navigate these complexities and ensure compliance with healthcare policies.

What is the difference between Provider Auditor vs Claims Auditor?

AspectProvider AuditorClaims Auditor
CertificationsCPA, CPC, or healthcare-specific certificationsCPA, CPC, or healthcare-specific certifications
Work EnvironmentHealthcare facilities, insurance companies, or government agenciesInsurance companies, healthcare organizations, or third-party auditing firms
Primary FocusAuditing healthcare providers' billing, coding, and complianceReviewing insurance claims for accuracy and fraud detection

Provider Auditors primarily focus on evaluating healthcare providers' billing and compliance practices, ensuring adherence to regulations. Claims Auditors concentrate on reviewing insurance claims for accuracy, fraud, and proper reimbursement. While both roles require similar certifications and work in healthcare or insurance settings, their core responsibilities differ—Provider Auditors assess provider practices, whereas Claims Auditors scrutinize insurance claims.

More about Provider Auditor jobs

What job categories do people searching Provider Auditor jobs look for?

The top searched job categories for Provider Auditor jobs are:

Provider Auditor jobs near you
Infographic showing various Provider Auditor job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $72,633 per year, or $34.9 per hour.

Investigative Services Auditor

Louisiana Legislative Auditor

Baton Rouge, LA • On-site

$83K/yr

Full-time

Re-posted 12 days ago

Job description

Overview
The LLA is seeking individuals to fill vacancies in our Investigative Audit Section. Our Investigative Staff Auditors are professional employees with a good working knowledge of investigations of complaints of fraud, waste and abuse involving state and local public funds. Auditors are expected to develop or possess effective verbal and written communication skills and work effectively with supervisors, team members and agency personnel.
Responsibilities
For more than 50 years, the LLA has helped the state of Louisiana foster accountability and transparency within Louisiana's government by providing the Legislature and others with audit services, fiscal advice, and other useful information.
Staff Auditor 1 has a minimum annual salary of $54,000.
Staff Auditor 2 has a minimum annual salary of $58,320.
Staff Auditor 3 has a minimum annual salary of $62,985.
Sr. Auditor 1 has a minimum annual salary of $76,000.
Sr. Auditor 2 has a minimum annual salary of $83,000.
The LLA is seeking individuals to fill vacancies in our Investigative Audit Section.
As part of our career progression framework, vacancies may be filled from this recruitment as a Staff or Senior Auditor depending on the level of experience of the selected applicant.
Qualifications
Minimum Qualifications
Eligible to take the Certified Public Accountant examination OR posses an advanced degree from an accredited college or university with at least 15 semester hours of accounting.
Examples of Work
Evidence and Documentation
  • Understand what evidence is needed to prove or disprove the assigned work.
  • Gather and safeguard digital and physical documents and evidence, according to the LLA's established procedures.
  • Document the source of all evidence at the time it is obtained.
  • Prepare work papers, including reports of interview, in a timely and accurate manner according to established practices.
  • Prepare well-organized, logical, concise, and clearly written documentation, to include proper grammar and spelling.
  • Take and document complaints of fraud, waste and abuse by phone or in-person from the general public for evaluation by management.

Communication
  • Assist in conducting effective interviews of auditees.
    • Understand the topics to be discussed and conduct appropriate background.
    • Use tactful and professional demeanor to build rapport with the interviewee.
    • Understand the law as it relates to interviews and a person's rights
  • Assist or prepare draft findings based on work performed and evidence collected, to include findings and recommendations sufficient to support legal proceedings.
  • Testify at court proceedings and legislative hearings.

Project Management
  • Organize project plans and workflow logically and efficiently to meet deadlines and time budgets.
  • Implement procedures throughout the project to effectively and efficiently address objectives.
  • Research state, federal, and local laws, rules, regulations, and ordinances. Review Attorney General Opinions and internal legal opinions.
  • Identify the methods used by alleged fraudsters and quantify the damages caused to agencies and others; evaluate the root causes of internal control failures; and make recommendations to remedy those failures.

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