Medicare Auditor - CONTRACT
Vaco LLC
louisville, KY
The Medicare Auditor is responsible for reviewing medical records, claims, and billing data to ensure compliance with Medicare regulations, including Medicare Part A and Medicare Part B requirements. This role evaluates documentation accuracy, coding correctness, medical necessity, and adherence to CMS guidelines to identify compliance risks, overpayments, and process improvement opportunities.
Key Responsibilities
- Conduct comprehensive audits of medical records and claims for Medicare Part A (inpatient, SNF, home health, hospice) and Medicare Part B (professional, outpatient, ancillary services).
- Review documentation, coding, and billing for accuracy, completeness, and compliance with CMS regulations, including LCDs, NCDs, and CCI edits.
- Validate appropriate use of ICD?10?CM, CPT, and HCPCS codes and ensure medical necessity is supported by clinical documentation.
- Identify billing errors, overpayments, underpayments, and compliance risks; document findings clearly and accurately.
- Prepare detailed audit reports outlining findings, trends, root causes, and recommended corrective actions.
- Provide feedback, education, and guidance to providers, coders, and billing staff to improve compliance and reduce future audit risk.
- Support internal and external audits, including Medicare Administrative Contractor (MAC) reviews and RAC audits as applicable.
- Stay current on changes to Medicare rules, regulations, and CMS guidance impacting Part A and Part B services.
- Collaborate with compliance, revenue cycle, coding, and clinical teams to support continuous process improvement.
- Maintain confidentiality and ensure compliance with HIPAA and organizational policies.
Vaco by Highspring values a diverse workplace and strongly encourages women, people of color, LGBTQ+ individuals, people with disabilities, members of ethnic minorities, foreign-born residents, and veterans to apply.
EEO Notice
Vaco by Highspring is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by federal, state or local law.
Vaco by Highspring and its parents, affiliates, and subsidiaries are committed to the full inclusion of all qualified individuals. As part of this commitment, Vaco by Highspring and its parents, affiliates, and subsidiaries will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact
HR@vaco.com
.Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal.
By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. You also agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal.
Privacy Notice
Vaco by Highspring and its parents, affiliates, and subsidiaries (“we,” “our,” or “Vaco by Highspring”) respects your privacy and are committed to providing transparent notice of our policies.
- California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here.
- Virginia residents may access our state specific policies here.
- Residents of all other states may access our policies here.
- Canadian residents may access our policies in English here and in French here.
- Residents of countries governed by GDPR may access our policies here.
Pay Transparency Notice
Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to:
- the individual’s skill sets, experience and training;
- licensure and certification requirements;
- office location and other geographic considerations;
- other business and organizational needs.
With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses.