Medical Auditor

Medical auditors perform coding quality audits and reviews of clinical documents, physician billing records, administrative data, and coding records. They ensure compliance with industry regulations as well as maintain quality assurance. They also provide ongoing feedback and analysis of the educational needs of the providers and staff. Certified medical auditors are also known as compliance auditors. This requires knowledge of federal, state, and payer-specific regulations (Medicare and Medicaid) and policies pertaining to documentation, coding, and billing. Knowledge of ICD-10-CM, CPT, and HCPCS coding is required.

The Medical Auditing curriculum prepares individuals for employment as healthcare auditors and compliance auditors.

Medical Offices
Dental Offices
Insurance Companies
Outpatient Surgical Facilities
Health Care Facilities
Health Care Consulting Firm

Jobs include: Medical Auditor, Health Care Auditor, Medical Billing Auditor, Compliance Auditor, Medical Coding Auditor, Medical Records Auditor, Clinical Auditor, Medical Coding Quality Auditor

Medical Terminology I & II
Word Processing
Office Applications I
Medical Insurance & Billing
Medical Legal Issues
Introduction to Anatomy & Physiology
Diagnostic Coding
Procedure Coding
Electronic Health Records
Medical Office Simulation
Long-Term Care Coding
Advanced Coding Methodologies
Medical Coding Certification
Medical Office Administration Capstone
Healthcare Customer Relations
Medical Auditing
Healthcare Compliance & Regulations
Advanced Medical Auditing

Students will demonstrate a proficiency in verifying medical coding and billing information for accuracy. They will learn the importance of compliance with healthcare regulations. Students will demonstrate a proficiency in reviewing patient records to ensure there is documentation for each service being billed. Students will learn how to abstract information from the patient record to ensure accurate diagnosis and procedure coding. Students will learn about federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing. Students will learn how to communicate audit results and findings to providers and staff of the medical facility. Students will apply federal privacy laws and HIPAA regulations to healthcare situations.

Most medical auditors are experienced medical coders with advanced training.