Pros and Cons of a Medicare Auditor Career
Medicare auditors make sure that medical bills are correctly coded and that Medicare is not being over or undercharged for doctor and hospital bills, which helps the system as a whole. Here are some of the pros and cons of a Medicare auditor career:
| Pros of a Medicare Auditor Career |
|---|
| Auditor's median salary is above average ($66,000 per year in 2014)* |
| Opportunity to help hospitals and other health care organizations earn rightful fees while avoiding Medicare fraud and abuse*** |
| Ability to use a variety of skill sets such as critical thinking, problem solving or math skills** |
| Provides opportunity for advancement for persons in fields such as nursing*** |
| Cons of a Medicare Auditor Career |
|---|
| Job may require traveling to locations where audit is being done* |
| May be high stress if you need to speak to medical providers about billing errors or irregularities*** |
| May have to work long hours* |
| Additional certification, such as in coding or medical auditing, may be required or preferred*** |
Sources: *U.S. Bureau of Labor Statistics (May 2014 information), **U.S. Department of Labor/O*Net (May 2012 information), ***Monster.com (May 2012 postings).
Essential Career Info
Job Description and Duties
Your auditor duties may include examining financial statements to determine if funds are being mismanaged, either through error or fraud, or if a company is noncompliant with current laws, regulations or contractual agreements. As a Medicare auditor, you'd make sure that patient charts are properly coded for billing and that physician practices, hospitals and other health care businesses that take care of Medicare patients are abiding by Medicare rules and regulations.
Medicare auditors may be hired by recovery auditing companies that contract with the Department of Health and Human Services. In such a position, you'd make sure that the federal government is not losing money due to overpaying claims (or in a few cases, not paying enough) based on erroneous or improper billing. Managed care companies, physician groups, hospitals and others health practitioners who bill Medicare may also hire or contract you as an auditor, to ensure that their billing practices, charting, and medical records are up to par, that they are not under billing or wasting money and that they are able to pass a Medicare audit. Some auditors may be specifically hired to review patient charts to see if they are correctly coded or to judge if a group is in compliance with federal regulations.
Job Growth and Salary
According to the U.S. Bureau of Labor Statistics, auditors and accountants had a median salary of about $66,000 per year as of 2014. Employment for auditors and accountants is expected to increase by 13% between 2012 and 2022.
Education Requirements
In order to work as a Medicare auditor, you would need at least a bachelor's degree. Job postings on Monster.com, CareerBuilder.com and Medicare recovery audit contractor companies indicate that additional education and certifications are often required or preferred depending on the position. . Some jobs, especially those that a examining charts for proper diagnosis codes, require or prefer someone who has a nursing degree. Other jobs request that you are a Certified Professional Coder (CPC) or a Certified Professional Medical Auditor, (CPMA) which requires training for and passing the national examinations. Most jobs also request that you have several months to several years of experience and a high level of familiarity with Medicare regulations. You must be highly detail-oriented and good with math, as well as have good communication and organizational skills.
Job Postings from Real Employers
Medicare auditors work on both sides of the table. Some work to save the government money, others work to make sure their organization is doing the right thing and avoiding problems. Many jobs also require that you have knowledge about Medicaid and other insurances. Here are a few of the available job postings from May 2012:
- A medical staffing company is looking for a nurse auditor to work in Nevada. You would examine the medical records of Medicare patients to determine if the billing codes accurately reflect what's in the record before the bill is submitted to Medicare. You'd be expected to document all results of the audit, and fill out a worksheet that includes discrepancies for educational feedback for the staff.
- A health insurance company in Oregon is hiring a Medicare compliance auditor. Duties would include helping monitor Medicare activities for the company and making sure it is in compliance with the Medicare program. You'd need at least one year experience in auditing or doing compliance work, such as conducting investigations or using or developing auditing tools. You'd also need at least a bachelor's degree in business, health care administration or public health (or an equivalent field); however, a law degree or a master's is preferred.
- A Medicare carrier company in Florida is hiring a Medicare review auditor. Duties include reviewing charts to find any diagnoses that were not billed and to code and bill for them appropriately for submission to Medicare. You'll need good oral and written communication skills, and strong computer skills. Candidates need to have an undergraduate degree, but someone with a nursing degree is preferred. You'll also need two years of experience in a medical office and you must have (or earn within six months of hire) your CPC or CPMA certification.
- A healthcare company is hiring a Medicare claims auditor to work in Louisiana. Job duties include finding and recovering Medicare payments that were erroneously paid to healthcare providers. You'll need at least two years of billing experience, and it's preferred if you have a bachelor's degree. Candidates should have good computer skills and strong analytical and problem solving skills. This job also requires traveling 75% of the time, both in and outside of Louisiana.
- A recovery audit contractor company is hiring a nurse auditor to work in Ohio. Some of the duties include finding and adjusting incorrect payments, perform repeat reviews of medical records to ensure correctness of original findings and help in developing corrective action plans. You'll need to be a registered nurse to apply for this position. Some of the other skills this employer is also looking for include experience in case management, good computer skills and understanding the criteria for hospital admission for Medicare and Medicaid.
How Can I Stand Out?
Most Medicare auditor jobs are looking for someone with experience, so any work that you can do in chart review, compliance with Medicare regulations or medical coding should help. Also, familiarity with word processing and spreadsheet software may make you a more appealing candidate for jobs.
Certification Choices
While not always required, obtaining certification appears to be a key way to stand out and increase your chances of getting hired as a Medicare auditor. The American Academy of Professional Coders (AAPC) certifies coders in both general and specialty areas. In addition to CPC, which is for medical practices, and CPMA, for medical auditing, there is CPCO for compliance, CPC-P for payers (health plans), CPC-H for hospital outpatient and CIRCC for interventional radiology. These and other more specialized coding certifications offered by the AAPC could make your skills stand out as a Medicare auditor.
Alternative Careers
Tax Examiner, Tax Collector or Revenue Agent
If you are interested in auditing but less interested in healthcare, you may want to become a tax revenue agent, collector or auditor. Persons in these jobs examine tax returns to determine if information is correct and all taxes were paid. They contact taxpayers to ask for more information and investigate to see if the information received is correct. Most tax agents, collectors and auditors have a bachelor's degree in accounting or a related field, specialized experience or a combination of education and experience. Job growth for persons in this field was expected to be seven percent between 2010 and 2020 by the BLS. Median salary for tax agents, collectors and auditors was about $50,000 in 2011, per BLS reports.
Financial Examiner
If you are mostly interested in compliance with financial laws and regulations, you might consider becoming a financial examiner. Financial examiners monitor financial institutions, such as banks, to make sure that they are in compliance with laws and regulations and that the system stays stable by not making risky loans and that the institution is able to cover losses. Some examiners work with consumers to make sure that borrowers are not subjected to predatory loans or otherwise taken advantage of by lending institutions. To become a financial examiner, you'll need a bachelor's degree that includes some work in accounting, as well as on-the-job- training. Median salary for financial examiners was about $75,000 in 2011, per BLS reports. The BLS also expected job growth in this field was 27% between 2010 and 2020.
