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Remote Rac Auditor Jobs (NOW HIRING)

Modernizing Medicine, Inc.

Medical Coding Auditor

... attending remote coding sessions with the global coding teams * Help with other daily ... Support in the review, appeal and follow-up of third-party (RAC, CERT, etc.) audits * Assist in ...

Pacs

$90K - $120K/yr

RAC-CT preferred. * Prior experience with clinical auditing and conducting internal investigations ... This role is remote, requiring less than 25% travel. Salary Range: $90,000 - $120,000 depending on ...

New

Jzanus Consulting

DRG Validator- Remote

Garden City, NY · Remote

$85K/yr

The validator is responsible for auditing inpatient medical records, ensuring the accuracy of ... and/or RAC Determinations. Provide written recommendations for optimal coding and DRG / SOI ...

Solventum

Anly Clinical Development

$96K - $132K/yr

Collaborate with consulting services, audit specialists, and other teams involved with auditing ... Remote - United States Travel: May include up to 10% domestic/international travel Must be legally ...

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How much do remote rac auditor jobs pay per year?

As of Aug 7, 2026, the average yearly pay for remote rac auditor in the United States is $86,952.00, according to ZipRecruiter salary data. Most workers in this role earn between $84,000.00 and $92,500.00 per year, depending on experience, location, and employer.

What does a remote RAC auditor do?

A typical day for a Remote RAC Auditor involves reviewing medical records and billing data to identify discrepancies or potential overpayments related to Medicare or Medicaid claims. You'll analyze documentation, prepare audit findings and reports, and communicate with healthcare providers to clarify any issues or request additional information. Most work is performed independently, but collaboration with audit teams, compliance officers, and sometimes legal or billing departments is common. Expect your day to be a mix of data analysis, documentation review, and written or virtual communication, all while managing multiple cases to meet strict deadlines.

What are the key skills and qualifications needed to thrive as a remote RAC auditor?

To thrive as a Remote RAC Auditor, you need a strong understanding of healthcare compliance, coding and billing practices, and knowledge of Medicare and Medicaid regulations, often supported by a degree in health information management or a related field. Proficiency with audit management software, electronic health records (EHR), and relevant certifications like Certified Coding Specialist (CCS) or Certified Professional Medical Auditor (CPMA) is typically required. Excellent analytical skills, attention to detail, and strong communication abilities are vital for collaborating with healthcare providers and delivering accurate audit results. These competencies are essential to ensure regulatory compliance, minimize financial risk, and maintain the integrity of healthcare reimbursement processes in a remote setting.

What is a remote RAC auditor?

A Remote RAC (Recovery Audit Contractor) Auditor is responsible for reviewing medical claims to ensure compliance with Medicare, Medicaid, and other insurance regulations. They analyze billing data, identify improper payments, and recommend corrections to prevent fraud, waste, and abuse. This role is performed remotely, requiring strong knowledge of coding guidelines, healthcare regulations, and auditing procedures. Remote RAC Auditors typically collaborate with healthcare providers and payers to resolve discrepancies and ensure accurate reimbursements.

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Remote Rac Auditor jobs near you
Infographic showing various Remote Rac 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 $86,952 per year, or $41.8 per hour.

Medical Review Nurse - CMS/RAC Auditor, Government Audits

Machinify

Remote

Full-time

Re-posted 13 days ago

Job description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
The Medical Review Nurse - CMS / RAC (Government Audits) primarily performs medical claims audit reviews for government clients. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.
Please note: RAC certification is preferred for this role. The selected candidate may need to work toward RAC certification if they do not currently have it.
Key Responsibilities:
  • Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
  • Document all findings referencing the appropriate policies and rules.
  • Generate letters articulating audit findings.
  • Supporting your findings during the appeals process if requested.
  • Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.
  • Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
  • Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
  • Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members.
  • Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
  • Interface with and support the Medical Director and cross train in all clinical departments/areas.
  • Other duties as required to meet business needs.

Knowledge, Skills and Abilities Needed:
  • Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.
  • Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding.
  • Knowledge of insurance programs program, particularly the coverage and payment rules.
  • Ability to maintain high quality work while meeting strict deadlines.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple tasks including desk audits and claims review.
  • Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.
  • Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload
  • Effectively work independently and as a team, in a remote setting.

Required and Preferred Qualifications:
  • Active unrestricted RN license in good standing, is required.
  • Must not be currently sanctioned or excluded from the Medicare program by the OIG.
  • Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
  • One (1) or more years' experience performing medical records review.
  • One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required.
  • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.
  • RAC certification preferred.

Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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