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Medical auditors review medical records and billing data to ensure accuracy and detect errors. They compare billing records with medical records and may uncover fraud or communication issues. This job requires attention to detail and confidentiality, and compensation varies depending on the workplace. Certification can increase employability.
A medical auditor is a person who reviews medical records and billing data to confirm that bills have been issued properly. Medical auditors improve the quality and accuracy of billing and help detect billing errors that can lead to underbilling and other issues. People can become medical auditors by taking training classes in medical billing and coding. It is recommended to seek certification through a professional organization in some areas as it can increase employability.
There are several reasons why an audit might be recommended. A medical auditor might be part of a quality improvement team working to identify a facility’s strengths and weaknesses, an internal employee who randomly selects items for review to maintain quality, or an employee of a government agency or insurance company who verifies the billing information. The work assigned to a medical auditor is confidential in nature as it involves personal patient records, and medical auditors must observe strict ethical practices while working.
The medical auditor compares a billing record with the patient’s medical record. If there are irregularities, such as billing codes for items not recorded on the chart or entries on the chart for procedures that were not billed, the auditor flags them. The auditor also seeks to determine whether the appropriate charge codes are being used for various procedures, office visits, consultations and tests.
A medical audit may not reveal any problems. It can also show that there are issues with billing and the auditor can determine if these are random or systemic. Medical auditors can uncover things like fraud, where doctors charge for procedures that are never performed and pocket the money, as well as unclear staff communication that leads to incorrect billing codes being entered for medical procedures. This can save money for insurance companies and government benefit plans, as well as improve efficiency in doctors’ offices.
Reviewing medical records is usually performed in a controlled office environment. A medical auditor may be required to pass a background check in order to function, due to concerns and possible compromises of information that could lead to identity theft or public disclosure of private medical information. This job requires attention to detail and the ability to sift through lengthy documents to look for irregularities. Compensation rates vary depending on where a medical auditor works, and benefits such as medical assistance may or may not be available; auditors working in clinics and hospitals may receive medical assistance as part of their compensation package.
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