How to Become a Certified Medical Auditor: Career Guide

Research the requirements to become a certified medical auditor. Learn about the job duties, and read the step-by-step process to start a career in medical auditing.

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Do I Want to Be a Certified Medical Auditor?

Certified medical auditors, also known as compliance auditors, perform audits and reviews of clinical documents, physician billing records, administrative data, and coding records. They ensure compliance with industry regulations and maintain quality assurance.

Certified medical auditors, like other types of auditors, usually work full-time, during business hours. Auditors usually work independently, though some collaboration with other auditors, medical office managers, or accountants might be necessary. They operate in an office setting and might travel to the locations of the medical offices they are auditing.

Job Requirements

Most certified medical auditors have a bachelor's degree in business, medical records technology, health services administration, or another healthcare-related field. Some are certified in medical coding or health information administration. The following table contains some of the common requirements to work in this field, according to online job ads posted in January 2013:

Common Requirements
Degree Level Bachelor's degree
Degree Field Business, medical records technology, health services administration, nursing or related field
Certification Registered Health Information Administrator (RHIA), Certified Medical Auditor Specialist (CMAS), Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) designations preferred
Experience3-5 years of experience in a coding or clinical position
Key Skills Strong communication, analytical and organizational skills, excellent writing and speaking skills, ability to maintain confidentiality, ability to work independently or in a team environment
Technical Skills Knowledge of Medicaid and Medicare, HIPAA and JCAHO / TJC regulations, understanding of CPT and ICD coding processes, medical terminology
Computer Skills Experience with MS Word, Excel and data entry

Step 1: Get a Bachelor's Degree

Several acceptable education paths allow one to become a certified medical auditor. A bachelor's degree program in business, health services administration or related administrative field can help prepare students for their careers in medical auditing. A bachelor's degree program in business administration may provide coursework in a variety of useful topics such as accounting and finance, business laws, anatomy and physiology and operations management. A health services administration degree program might provide coursework in health economics, health administration, management and organizational behavior, managed care and related topics. A degree in nursing would provide a more clinical-based education that can be applied to a career in medical auditing.

Step 2: Gain Work Experience

Most employers require candidates to have 3-5 years of experience in coding or legal, regulatory, nursing or healthcare compliance position. An entry-level healthcare administrative position or clinical nursing experience can be useful when looking for employment as a medical auditor. Candidates should have a strong knowledge base in medical terminology, coding processes and healthcare laws and regulations before seeking a position as a certified medical auditor.

Step 3: Get Certified

Many certifications are accepted by employers for a certified medical auditor position. The American Health Information Management Association (AHIMA) offers an RHIA designation that shows competency in health information and records management and knowledge of medical ethics and law. Requirements include graduation from an accredited bachelor's degree program in a healthcare-related field. The CCS designation shows competency in medical coding and billing practices and knowledge of medical terminology, disease processes and other related topics. Requirements vary and include previous RHIA certification, 1-2 years of coding experience or completion of a coding education program. Both certification programs require passing a written examination.

The American Association of Medical Audit Specialists (AAMAS) offers a Certified Medical Audit Specialist (CMAS) designation that demonstrates an auditor's professional integrity and knowledge. Requirements include 2 years of experience in healthcare claims auditing, completion of an accounting, finance or related education program or experience as a licensed healthcare professional. Applicants must become members of the AAMAS to apply. Applicants must pass a written examination to become certified.

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