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Provider Auditor Jobs (NOW HIRING)

St. Luke's Health Network, Inc.

$14.25 - $19/hr

The Network Provider Services Auditor performs audits as part of the Documentation and Coding Compliance Program for professional services billed by providers employed with St. Luke's Physician Group ...

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$30.5K

$72.6K

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How much do provider auditor jobs pay per year?

As of Jun 7, 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 are the key skills and qualifications needed to thrive as a Provider Auditor, and why are they important?

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 are Provider Auditors?

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 are some common challenges 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 May 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $72,633 per year, or $34.9 per hour.

Provider Services Auditor

St. Luke's Health Network, Inc.

Northampton, PA

$14.25 - $19/hr

Full-time

Posted 19 days ago

Job description

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St.

Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Network Provider Services Auditor performs audits as part of the Documentation and Coding Compliance Program for professional services billed by providers employed with St.

Luke’s Physician Group (SLPG). In doing so, works with providers and their office staff, as well as the Coding and SLPG Billing Department. JOB DUTIES AND RESPONSIBILITIES: Perform quality audits to include reviewing medical record documentation for completeness and accuracy to support billed claims.

Generate provider reports through billing software. Coordinates, schedules, and meet with providers to perform education for the professional service documentation and coding audits of both office and in-patient medical records. Maintain and record audits in Excel spreadsheet format and through an auditing software program.

Is a resource to the coding department, SLPG practices, providers, and billing department. Assisting with the development of training materials for compliance education and training modules. Provides training classes to new providers throughout the year along with providing education to the Residency programs.

Maintain current knowledge of coding and documentation educational updates for primary care and specialty services. Assists in the formulation and review of Network policies and guidelines affecting the coding of professional services. Assists in maintaining the FY audit plan and accurate accounting of time allocated to each audited provider.

Analyzing data in Excel or other software programs and making sound recommendations based on the results. PHYSICAL AND SENSORY REQUIREMENTS: Sitting for up to eight hours per day. Driving distances up to 50 miles one way.

Must possess hearing, seeing, speaking and reasoning senses necessary to carry out job duties. Occasional lifting/carrying of objects such as office supplies, files, etc. with maximum of ten pounds.

Walking, bending, twisting and reaching necessary to carry out duties of job. EDUCATION AND TRAINING: High school diploma or equivalent required. Certification of CPC, CCS, or CCS-P highly desired OR Coding certification within one year.

Working knowledge of ICD-9, CPT, and HCPCS coding required. TRAINING AND EXPERIENCE: At least 2 years of healthcare experience with background and competency in coding and documentation State and Federal regulatory requirements including Medicare, Medicaid and third-party payers as well as strong written/verbal communications skills preferred. Strong computing and data management abilities, analytical, and interpersonal and communication skills which are all essential skills.

Microsoft office skills to include word, Excel and Power Point Presentations Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable.

It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.

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