What does a medical auditor do?
Medical auditors are in charge of precise documentation, unaccountable operations, and determining areas for enhancement for any healthcare organization. Their responsibilities include conducting an internal and external assessment of coding accuracy, policies, and strategies to make sure a systematic and feasible delivery of care. Also, they determine any erroneous or misplaced documentation that could lead to negative consequences for their equipment. Additionally, they educate their medical on correct documenting protocols and give updates with new codings, insurance, and government guidelines.
Medical auditor responsibilities
Here are examples of responsibilities from real medical auditor resumes:
- Review confidential and substantial health documentation and make sound, evidence-base decisions concerning compliance to HIPPA and other manage care policies.
- Handle and interpret medical documentation such as UB04 claim forms and EOB's on a daily basis.
- Review all EOB's to ensure claim paid per contract and submit appeals for claims underpay or deny payment in error.
- Review medical records to determine if clinical documentation support coding and DRG assignments.
- Advance knowledge - CMS and provider contract rules.
- Process HCFA and UB claims in a production environment.
- Assign CPT and ICD-9 codes to all radiology procedures.
- Prepare and key monthly workload/quarterly savings report to CMS.
- Reorganize the ROI process to decrease backlog and increase efficiency.
- Monitor systems and alerts relate to HL7 and LIS interfaces.
- Submit additional HCC codes find in the medical record for reimbursement.
- Handle doctor tax identification and ICD-9 coding for proper claim submission.
- Code records by following prescribe coding standards such as ICD-9 and CPT.
- Review documentation in areas of office E/M, surgical and inpatient E/M coding.
- Pull operative and radiology reports off of PCI from ACH to send to insurance.
Medical auditor skills and personality traits
We calculated that 12% of Medical Auditors are proficient in ICD-10, HCPCS, and HIPAA. They’re also known for soft skills such as Analytical skills, Detail oriented, and Integrity.
We break down the percentage of Medical Auditors that have these skills listed on their resume here:
- ICD-10, 12%
Charge Auditor Coder, review and audit patient charts for accurate ICD-10 / CPT coding for Medical billing system.
- HCPCS, 10%
Adhered to regulations with CPT-4, ICD-9-CM and HCPCS coding with medical terminology and effort met all audit requirements.
- HIPAA, 9%
Comply with Medicare and HIPAA privacy laws, state laws and related health information, confidentiality, medical record regulations.
- Patients, 8%
Established and detected a variety of insurances for non-covered patients.
- Surgery, 6%
Retrieved specific records and documents for emergency room, critical care unit, medical surgery and cardiology departments.
- Audit Findings, 5%
Prepared written reports of audit findings including explanations of recovery of money to leadership, providers and provider relations department.
"icd-10," "hcpcs," and "hipaa" are among the most common skills that medical auditors use at work. You can find even more medical auditor responsibilities below, including:
Analytical skills. One of the key soft skills for a medical auditor to have is analytical skills. You can see how this relates to what medical auditors do because "health information technicians must understand and follow medical records and diagnoses, and then decide how best to code them in a patient’s medical records." Additionally, a medical auditor resume shows how medical auditors use analytical skills: "validate hedis data to ensure accuracy, quality, and integrity. "
Detail oriented. Many medical auditor duties rely on detail oriented. "health information technicians must be accurate when recording and coding patient information.," so a medical auditor will need this skill often in their role. This resume example is just one of many ways medical auditor responsibilities rely on detail oriented: "utilize icd code 9 and risk medicare adjustment for performing auditing medical charts in details. "
Integrity. Another skill that relates to the job responsibilities of medical auditors is integrity. This skill is critical to many everyday medical auditor duties, as "health information technicians work with patient data that are required, by law, to be kept confidential." This example from a resume shows how this skill is used: "examine and evaluate audit results, recommending controls to ensure system reliability and data integrity. "
Technical skills. medical auditor responsibilities often require "technical skills." The duties that rely on this skill are shown by the fact that "health information technicians must use coding and classification software and the electronic health record (ehr) system that their healthcare organization or physician practice has adopted." This resume example shows what medical auditors do with technical skills on a typical day: "utilized technical coding principals and ms-drg reimbursement expertise to assign appropriate icd-9-cm diagnoses and procedures. "
The three companies that hire the most medical auditors are:
- Guidehouse51 medical auditors jobs
- Evolent Health44 medical auditors jobs
- McKesson8 medical auditors jobs
Choose from 10+ customizable medical auditor resume templates
Build a professional medical auditor resume in minutes. Our AI resume writing assistant will guide you through every step of the process, and you can choose from 10+ resume templates to create your medical auditor resume.
Compare different medical auditors
Medical auditor vs. Health information technician
A health information technician is primarily responsible for managing and handling patient information, ensuring accuracy and confidentiality. They coordinate with various health care workers to gather patient data, laboratory results, test findings, and medical histories, encoding them in clinical databases in a timely and efficient manner. They must analyze every information to detect any inconsistencies, performing corrective measures right away. Furthermore, as a health information technician, it is essential to utilize particular software and systems when processing information, all while adhering to the hospital's policies and regulations.
While similarities exist, there are also some differences between medical auditors and health information technician. For instance, medical auditor responsibilities require skills such as "icd-10," "hcpcs," "surgery," and "audit findings." Whereas a health information technician is skilled in "customer service," "office equipment," "transcription," and "rehabilitation." This is part of what separates the two careers.
Health information technicians really shine in the government industry with an average salary of $35,705. Comparatively, medical auditors tend to make the most money in the insurance industry with an average salary of $58,395.health information technicians tend to reach lower levels of education than medical auditors. In fact, health information technicians are 5.2% less likely to graduate with a Master's Degree and 5.0% less likely to have a Doctoral Degree.Medical auditor vs. Records manager
The records manager is an important position that handles the creation, organization, and disposal of records. They are also responsible for establishing systems for their management and the maintenance, verification, and evaluation of extant systems. It will require technical and analytical skills, as well as a great deal of integrity for handling sensitive information.
Each career also uses different skills, according to real medical auditor resumes. While medical auditor responsibilities can utilize skills like "icd-10," "hcpcs," "patients," and "surgery," records managers use skills like "office equipment," "access database," "sharepoint," and "nara."
Records managers may earn a lower salary than medical auditors, but records managers earn the most pay in the professional industry with an average salary of $58,862. On the other hand, medical auditors receive higher pay in the insurance industry, where they earn an average salary of $58,395.records managers earn similar levels of education than medical auditors in general. They're 1.7% more likely to graduate with a Master's Degree and 5.0% less likely to earn a Doctoral Degree.Medical auditor vs. Health information specialist
A health information specialist is in charge of overseeing and developing strategies to optimize information management procedures in hospitals, physicians' offices, and other similar environments. Their responsibilities revolve around gathering and updating medical records, receiving and organizing files, and updating databases according to the appropriate coding systems and procedures. Furthermore, as a health information specialist, it is essential to coordinate with nurses and other staff to ensure accuracy in documentation, all while adhering to the company's policies and regulations.
The required skills of the two careers differ considerably. For example, medical auditors are more likely to have skills like "hcpcs," "surgery," "audit findings," and "e/m." But a health information specialist is more likely to have skills like "excellent organizational," "cycle management," "office equipment," and "cerner."
Health information specialists earn the highest salary when working in the health care industry, where they receive an average salary of $33,177. Comparatively, medical auditors have the highest earning potential in the insurance industry, with an average salary of $58,395.When it comes to education, health information specialists tend to earn similar degree levels compared to medical auditors. In fact, they're 3.9% less likely to earn a Master's Degree, and 4.9% less likely to graduate with a Doctoral Degree.Medical auditor vs. Recording technician
A recording technician specializes in operating audio systems and equipment for various purposes such as recordings, broadcasts, and events. It is their responsibility to prepare equipment according to project or program requirements like microphones, audio lines, speakers, and amplifiers, ensuring everything is accounted for and is functioning efficiently. Aside from setting up equipment, they must also conduct regular maintenance checks and perform repairs as necessary. Moreover, as a recording technician, it is essential to maintain an active communication line with staff for a smooth and efficient workflow.
Even though a few skill sets overlap between medical auditors and recording technicians, there are some differences that are important to note. For one, a medical auditor might have more use for skills like "icd-10," "hcpcs," "patients," and "surgery." Meanwhile, some responsibilities of recording technicians require skills like "customer service," "database systems," "office equipment," and "background checks. "
The government industry tends to pay the highest salaries for recording technicians, with average annual pay of $38,663. Comparatively, the highest medical auditor annual salary comes from the insurance industry.The average resume of recording technicians showed that they earn similar levels of education compared to medical auditors. So much so that theyacirc;euro;trade;re 4.4% less likely to earn a Master's Degree and less likely to earn a Doctoral Degree by 4.7%.Types of medical auditor
Updated January 8, 2025
