Pros and Cons of a Career as a Medical Claims Auditor
A medical claims auditor, also called a medical coding auditor, is a medical coding professional who ensures that medical claims, medical records and other documentation essential to the healthcare industry is in compliance with federal and industry standards. To learn more about whether this career is right for you, take a look at the pros and cons of being a medical claims auditor.
| Pros of a Career as a Medical Claims Auditor |
|---|
| Strong employment outlook (national employment of medical claims auditors is projected to grow faster than the average for all other occupations from 2012-2022)* |
| Job security (a shortage of medical coding professionals and the federal government's strong emphasis on compliance standards make these services highly valued to many employers)** |
| Relatively good pay ($34,000-$74,000 as of July 2015)*** |
| Relaxed environment (no physical toil or highly stressful deadlines associated with this occupation. For the most part, you'll be in a climate-controlled office for most of the day)* |
| Cons of a Career as a Medical Claims Auditor |
|---|
| Ceiling on advancement (if you're looking to advance into a hospital administrative position with this career, you may need to reconsider becoming a claims auditor or prepare to transition to another career that may allow you more promotional opportunities)* |
| Confined to a desk (the fact that auditors must stay in one place for long periods of time may be uncomfortable for someone who likes moving around throughout the day)* |
| Long hours in front of computer (possible eye strain and a potential to develop carpal tunnel from sitting at a computer terminal for long periods of time)* |
| Constant adaptation (since the medical coding profession is in the middle of acclimating itself to new technologies, the responsibilities and fluctuating professional methods of this occupation may take some getting used to)* |
Sources: *U.S. Bureau of Labor Statistics, **American Academy of Professional Coders, ***Payscale.com.
Career Information
Job Description and Duties
As a medical claims auditor, you'll have many responsibilities similar to those of medical coders, such as utilizing CPT, ICD-9 and other coding systems in the medical billing process; ordering lab tests; reviewing transcribed physician notes and contacting insurance agencies about claims. Unlike that of conventional coders, however, your work will place stronger emphasis on compliance and regulatory standards.
This means that you'll focus not only on processing medical claims, but also on making sure that those claims are processed accurately and according to government standards. Some of your specific responsibilities may include detecting unlawful Medicare payments, conducting quality assurance assessments, reviewing statistical samples, filing financial data and reviewing third-party audits.
Job Prospects and Salary Info
According to the U.S. Bureau of Labor Statistics (BLS), national employment of all medical records and health information technicians was projected to grow by 22% from 2012-2022 (www.bls.gov). Payscale.com estimated the national salary average of medical coding auditors to range from $34,000-$74,000 as of July 2015.
Career Paths and Specializations
Medical claims auditors may work in a variety of professional settings, such as health maintenance organizations (HMOs), private doctors' offices, long-term care facilities and government agencies. Since the 2003 enactment of the Medicare Modernization Act, a niche has been open for claims auditors seeking to specialize in verifying the lawfulness of certain types of Medicare payments to healthcare providers. These professionals are typically referred to as recovery contract auditors.
The type of coding system in which a claims auditor is proficient can also be a form of specialization. A variety of coding systems are used in the medical coding profession, but employers may only utilize a few. In fact, some job postings may specify for applicants trained in certain coding systems. These may include the Current Procedural Terminology (CPT), the International Classification of Diseases (ICD) and the Healthcare Common Procedure Coding System (HCPCS).
Career Skills and Requirements
The minimum education requirements for entry-level work as a medical claims auditor may vary by employer, some of whom may require as little as a high school diploma or its equivalent. Most jobs in the field require candidates to have completed at least a relevant certificate program and hold some form of professional certification. Students in postsecondary training programs in medical coding or an equivalent subject may gain knowledge and training in a variety of areas, such as medical coding theory, advanced coding languages and medical coding applications.
Useful Skills
As a medical claims auditor, you'll need to rely on a range of analytical, technical and interpersonal skills to successfully complete most professional tasks. Some specific skills may include:
- The ability to match the information in medical records, such as diseases, with their proper codes
- The ability communicate patient data with other medical personnel
- The ability operate computerized coding technology
- The ability to pay strict attention to details
- The ability to follow instructions in precisely the manner in which they are laid out
Job Postings from Real Employers
The numerous postings for medical claims auditors that turned up during an April-May 2012 job search conducted on Careerbuilder.com varied as to credentials, education and experience required. Most required applicants to have proficiency in more than coding system as well as in basic word processing and data processing software. The following describes several actual postings among those found in the search:
- A Georgia healthcare services company advertised for a medical claims auditor to work in its Boston location. The successful applicant would have experience in managed care reimbursement, hold at least a bachelor's degree and/or certification in hospital coding and be proficient in several healthcare coding languages.
- A Texas health services company advertised for a medical claims auditor with at least a high school diploma, a firm grasp of medical terminology and proficiency in several coding languages.
- A managed care company in Florida looked for a medical claims auditor with at least an associate's degree in healthcare, sufficient experience in processing Medicare claims and/or a combination of education and experience. This employer also required that candidates have the ability to communicate in both Spanish and English.
How to Stand Out
Employers typically prefer candidates who are knowledgeable and certified in the coding system or systems in which they operate. You can gain additional knowledge and credentials by joining professional organizations and/or enrolling in certificate or associate's degree programs at community colleges.
Continuing Education
You may gain considerable leverage over the competition by learning as many different coding applications and systems as possible. This may open you to a range of different employment possibilities, particularly those positions that require applicants to have expertise and experience in a very specific coding system. Professional organizations, such as the American Academy of Professional Coders (AAPC) and the Professional Association of Healthcare Coding Specialists (PAHCS), offer a variety of continuing education opportunities, such as webinars, conferences, certification specialties and professional workshops. In addition, you may earn certificate and/or associate's degree credits in a variety of coding specialties at community colleges.
Certification
There are many benefits to attaining certification as a medical coding auditor. Not only does certification bring added legitimacy to your resume, it may also allow you to earn more than non-certified coding professionals. Several associations, such as the AAPC and the PAHCS, grant a variety of certifications to coding professionals.
Other Careers to Consider
If you'd like to work with medical records, but not necessarily learn coding, you can look at becoming a medical transcriptionist. Transcriptionists, like medical claims auditors, must review, interpret and/or prepare a variety of medical documentation, such as patient data reports, physician notes and discharge summaries. Transcriptionists' work focuses primarily on transcribing doctors' oral notes and interpreting documents. The BLS projected job growth of six percent for medical transcriptionists from 2010-2020. As of May 2012, their median annual salary was about $33,000.
If you'd like a career in the medical field with prospects for strong growth, consider becoming a medical assistant. Medical assistants, like medical claims auditors, are also healthcare professionals. They have similar clerical duties as auditors, such as scheduling appointments. Unlike auditors, however, these professionals also work directly with patients during tasks such as taking vital signs, preparing blood tests and assisting doctors with physical examinations. The BLS projected job growth of 31%, much faster than the average for all occupations, for medical assistants from 2010-2020. As of May 2012, the median annual salary for medical assistants was about $29,000.
