A medical auditor examines medical records and billing data to ensure that bills have been issued correctly. Medical auditors improve billing accuracy and quality, as well as catching billing errors that can lead to underbilling and other issues. Medical auditors can become certified by taking medical billing and coding classes. In some fields, obtaining certification through a professional organization is recommended because it can improve employability.
An audit may be recommended for a variety of reasons. A medical auditor could be a member of a quality improvement team tasked with identifying a facility’s strengths and weaknesses, an internal employee tasked with randomly selecting items for review in order to maintain quality, or a government or insurance company employee tasked with verifying billing information. Medical auditors’ work is confidential because it involves personal patient records, and they must follow strict ethical guidelines while performing their duties.
A billing record is compared to a patient’s chart by a medical auditor. The auditor flags any irregularities, such as billing codes for things that aren’t recorded in the chart or entries in the chart for procedures that aren’t billed. The auditor will also check to see if proper billing codes are being used for various procedures, office visits, consultations, and tests.
A medical audit may or may not reveal any problems. It could also indicate that there are billing issues, which the auditor can determine whether they are random or systemic. Medical auditors can uncover issues such as billing for procedures that were never performed and pocketing the money, as well as a lack of clear staff communication that leads to incorrect billing codes for medical procedures. This can help insurance companies and government benefit plans save money while also increasing the efficiency of medical offices.
Medical records are usually reviewed in a controlled office setting. Due to concerns and potential information compromises that could lead to identity theft or public disclosure of private medical information, a medical auditor may be required to pass a background check in order to work. This job necessitates a keen eye for detail as well as the ability to pore over large documents in search of inconsistencies. Medical auditors’ pay varies depending on where they work, and benefits such as healthcare may or may not be included in their compensation package; auditors who work for clinics and hospitals may receive healthcare as part of their compensation package.