Medical records auditors review coded medical records and supporting documents to ensure accuracy and efficiency. This process helps to prevent and to identify fraud, overpayments, potential problems with regulatory compliance and investigations by regulatory agencies. Medical records auditors typically work for health care organizations, though some may work for government agencies.
Required Skills and Knowledge
Medical records auditors must be experts on medical coding systems, such as the Current Procedural Terminology and International Classification of Diseases systems, and medical billing and reimbursement procedures. You must have an acute eye for detail to be able to identify technical problems with these complex codes. You must have excellent written communication skills to relay problems to management, to advise on new or updated procedures to prevent future medical records issues and to write reports on the results of your audits. You also need advanced knowledge of medical records laws and regulations.
As a medical records auditor, you spend much of your time conducting research and analysis. You first gather a sample group of medical records to review. The specifications of this sample group may vary depending on the purpose of your audit. For example, an audit may be necessary after customers complain that their insurers didn't receive the proper documentation to authorize payment for blood tests. In this case, your sample would include patients who have undergone blood tests during the relevant time period. After identifying a sample, you review medical records and supporting documentation and speak with staff members involved in providing care to determine accuracy and to identify the cause of mismanaged medical records.
Compliance and Advising Duties
In a medical records auditing position, you are responsible for ensuring that the staff and policies of a health care organization comply with regulatory requirements and maintaining the confidentiality of a health care organization's records. You may be required to train medical or coding staff to understand and to apply coding and billing policies, laws and regulations. You also may advise management to develop more effective policies and procedures and communicate with third-party payers, which includes insurance companies and government payers regarding medical coding or billing issues. Medical records auditors must attend training events to stay up to date on regulation and the latest revisions to coding systems.
Ideal Medical Records Auditor Background
You need at least a certificate or associate degree in health information technology to work as a medical records auditor, though some employers prefer candidates with a bachelor's degree. These programs provide training for medical terminology, coding systems, regulatory requirements and health care reimbursement. After graduation, you must gain several years of experience as a medical records or health information technician before moving up to an auditor position. Once you enter the field, you can certify your expertise by passing the Certified Professional Medical Auditor exam. There are no strict education or experience requirements for this exam, but the American Academy of Professional Coders recommends that you have an associate degree and two years of medical auditing experience before attempting the exam.
- University of New Mexico: Medical Coding Auditor Position Classification Description
- Saint Louis University: Auditor (Medical Records) Staff Job Composite
- American Academy of Professional Coders: What Is Medical Auditing?
- American Academy of Professional Coders: Certified Professional Medical Auditor
- Healthcare Resolution Services: Medical Record Audit
- Society of Teachers of Family Medicine: Medical Record Audit
- U.S. Bureau of Labor Statistics: Medical Records and Health Information Technicians
- American Medical Association: About CPT
- World Health Organization: International Classification of Diseases
- Jupiterimages/Photos.com/Getty Images