Our Medical Auditor job description includes the responsibilities, duties, skills, education, qualifications, and experience.
About the Medical Auditor role
A Medical Auditor is responsible for reviewing medical records to ensure accuracy, completeness, and compliance with applicable laws, regulations, and standards. They analyze medical documents to identify errors or irregularities, and make recommendations for corrective action. They also provide education to medical staff on proper documentation and compliance.
Role Purpose
The purpose of a Medical Auditor is to review medical records and associated documentation to ensure they are complete, accurate, and compliant with relevant regulations. This individual must have an in-depth understanding of medical coding and billing procedures, as well as a thorough understanding of applicable laws, regulations, and guidelines. The Medical Auditor is responsible for performing detailed audits of medical records and other data to identify errors and inaccuracies, and to assess the accuracy of claims submitted for payment. The auditor will also provide guidance and assistance to medical providers on how to improve their documentation and coding practices. The ultimate goal is to ensure that all medical services are properly documented, coded, and billed in order to maximize reimbursement and minimize fraud and abuse.
Medical Auditor Summary
A Medical Auditor is responsible for conducting reviews of medical records and claims for accuracy and compliance with applicable regulations. The auditor must have a thorough knowledge and understanding of medical coding and billing processes, as well as an understanding of medical terminology, anatomy and physiology. The auditor must also be able to interpret and explain the specific requirements of insurance companies, and be familiar with the methods of documentation and coding used by the organization. Responsibilities include reviewing claims and documentation for completeness, accuracy, compliance, and appropriateness; analyzing coding accuracy; managing the development of audit and compliance programs; and providing guidance to staff on coding and billing issues. The auditor must be able to communicate effectively with other staff members, insurance companies, and providers.
Medical Auditor Duties
- Review medical records to ensure accuracy and compliance with applicable regulations
- Analyze medical data for cost efficiency and appropriateness of care
- Identify opportunities for improvement in medical billing and coding processes
- Recommend process changes to healthcare organizations
- Prepare detailed reports of audit findings
Medical Auditor Skills
- Analyzing medical records and claims
- Performing medical coding
- Identifying discrepancies in billing and coding
- Communicating with healthcare providers
- Understanding of medical terminology and insurance coverage
- Building and maintaining professional relationships
Medical Auditor Requirements
- Bachelor's degree in a related field
- Previous experience in healthcare auditing
- Knowledge of medical coding and reimbursement
- Proficiency with data analysis software
- Strong problem-solving and communication skills
Personal Traits
- Strong analytical skills
- Attention to detail
- Knowledge of medical coding systems
- Ability to work independently