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How much do rn rac auditor jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for rn rac auditor in the United States is $32.99, according to ZipRecruiter salary data. Most workers in this role earn between $28.85 and $36.06 per hour, depending on experience, location, and employer.

What is an RN RAC Auditor?

An RN RAC (Recovery Audit Contractor) Auditor is a registered nurse who reviews medical records to ensure compliance with Medicare and Medicaid billing regulations. They analyze documentation, identify improper payments, and help healthcare providers correct billing errors. Their role is crucial in preventing fraud, ensuring accurate reimbursement, and improving healthcare compliance.

What are the key skills and qualifications needed to thrive as an RN RAC Auditor?

To thrive as an RN RAC Auditor, you need a current RN license, strong clinical background, and in-depth knowledge of Medicare and healthcare reimbursement systems. Familiarity with tools such as electronic health records (EHRs), the Resident Assessment Instrument (RAI), and coding software like ICD-10 is crucial, and certification such as RAC-CT (Resident Assessment Coordinator-Certified) is often preferred. Attention to detail, analytical thinking, and strong written and verbal communication are valuable soft skills for auditing complex medical records and collaborating with interdisciplinary teams. These competencies ensure accurate compliance, optimal reimbursement, and the maintenance of high regulatory standards within healthcare organizations.

What are some common challenges faced by RN RAC Auditors in their daily work?

RN RAC Auditors often encounter challenges such as keeping up with frequently changing Medicare regulations, ensuring meticulous accuracy in clinical documentation, and coordinating with various healthcare professionals to resolve discrepancies. The role may require balancing multiple audits simultaneously and adapting quickly to new software or compliance standards. Successful RAC Auditors rely on strong organizational skills and up-to-date industry knowledge to navigate these challenges and support their facility’s compliance and reimbursement objectives. Most auditors work closely with MDS coordinators, billing departments, and clinical teams, making clear communication and teamwork essential. Staying proactive with ongoing education and training can also help ease these hurdles and contribute to long-term career growth.

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Rn Rac Auditor jobs near you
Infographic showing various Rn Rac Auditor job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 48% Full Time, 14% Part Time, and 34% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $68,617 per year, or $33 per hour.

Medical Review Nurse - CMS/RAC Auditor, Government Audits

Machinify

Remote

Full-time

Re-posted 22 days ago

Job description

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.

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