Nurse Auditor Certification and Certificate Program Info

Nurse auditors combine their knowledge of medical procedures with their understanding of medical billing and coding systems to guarantee accurate patient and third-party billing and reimbursement. Although there are no formal nurse auditor certificate programs, professional nurses seeking to expand their career opportunities may want to think about pursuing nurse auditor certification.

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Nurse Auditor Certification

In today's complex and ever-changing healthcare industry, a patient's medical record is more than a list of illnesses and outcomes. The medical record has become the primary tool for determining not only the efficacy of specific treatment but also for assigning financial responsibility for said treatment. The review and analysis of these records is the primary responsibility of the nurse auditor.

Registered nurses interested in nurse auditor certification may apply to the American Association of Clinical Coders and Auditors (AACCA). The AACCA is the only non-profit, industry-standard organization in the United States offering certification for nurse auditors. They also offer study aids, test preparation materials and continuing education opportunities. The certification exam is administered online and test results are available immediately upon completion (www.aacca.net).

Education Prerequisites

In order to qualify to sit for the nurse auditor certification exam, individuals must be a licensed registered nurse in their state of residence. Also, certification candidates must be active members in good standing of the AACCA. There are no work experience requirements to register for the exam. However, because of the in-depth nature of the test, it is recommended that certification candidates have at least one year of medical coding experience prior to registering for the exam.

Certification Coursework

Nurse auditors must have a broad range of knowledge to perform their appointed tasks. They must be knowledgeable of healthcare institution services and policies, medical treatments and terminology and the latest in insurance and governmental guidelines and regulations. Below are listed some core components covered by the nurse auditor certification exam.

  • Chart audits
  • Diagnostic coding guidelines
  • Medical fraud and abuse
  • 3rd-party reimbursement
  • Coding operative reports

Employment Outlook and Salary Information

Payscale.com shows a median salary for nurse auditors in November 2013 of $63,013. Meanwhile, the U.S. Bureau of Labor Statistics' median salary for all nurses was $65,470 in 2012. While the BLS doesn't provide employment outlook specifically for nurse auditors, it does report that registered nurses overall should enjoy a 26% increase in jobs over the 2010-2020 decade, which is much faster than the average for all occupations.

Certificate Programs and Continuing Education Information

There are no stand-alone certificate programs for nurse auditors. Individuals interested in becoming a nurse auditor must first complete an accredited nursing program. Then, once nursing licensure is obtained, individuals gain the needed coding and billing experience by working at a healthcare facility. In this way, the career path of nurse auditor is open only to experienced professional nurses. It is not an entry-level position.

Because of the ever-changing nature of healthcare rules and regulations, nurse auditors may find it advantageous to enroll in continuing education courses. These courses can provide knowledge and insight into topics such as changes in Medicare and Medicaid reimbursement and other medical coding issues. In addition to its other services, the AACCA offers continuing education courses on a range of coding, auditing and billing topics.

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