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How to Become a Medicare Auditor: Step-by-Step Career Guide

Learn how to become a Medicare auditor. Research the job description and the education requirements, and find out how to start a career in Medicare auditing.

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Do I Want to Be a Medicare Auditor?

Medicare auditors, also known as health insurance specialists, work with and for the government insurance program Medicare. They ensure that state Medicare programs and Medicare-contracted agencies adhere to government regulations. Much of auditors' time is spent in close evaluation of Medicare applications, the dispersal of funds, and the paper trail associated with the Medicare healthcare system.

Most Medicare auditors are employed full-time. Those who are employed by doctors' offices and hospitals may have minimal exposure to infectious diseases. The job requires little physical activity, and such auditors work in an office setting. They must be excellent communicators and work well in a team, as well as with the public.

Job Requirements

People in this position typically possess a high school diploma or postsecondary education and have experience with Medicare. The following table outlines the core requirements for Medicare auditors:

Common Requirements
Degree Level High school diploma; a bachelor's degree or higher can help candidates advance more quickly*
Degree Fields Business, law, healthcare administration or a related field*
Experience Several years of experience with the federal government; education may be substituted for experience in some jobs*
Key Skills Critical thinking, decision making and problem solving abilities**
Computer Skills Experience with claims processing software**

Sources: *Center for Medicare & Medicaid Services, **ONet Online.

Step 1: Get an Education

Some Medicare auditors only need a high school diploma or the equivalent, but those with an associate's or bachelor's degree can advance to an auditing position more quickly. Since programs specifically for Medicare auditors don't exist, students may pursue a degree in business, finance, law or an insurance- or healthcare-related field. These degree programs typically involve courses in research, finance, health insurance and healthcare law.

Success Tips:

  • Develop communication skills. Auditors must have strong oral and written communication skills to collect necessary information about state programs and collaborate with other departments. Courses in mass communication, English and public speaking can strengthen these skills.
  • Complete an internship. Students can gain auditing experience as interns in a medical, healthcare or insurance setting. Interns may be responsible for conducting audits and presenting results to managers. In these positions, aspiring Medicare workers can learn auditing procedures and job-specific software.

Step 2: Work for the Federal Government

Medicare auditor positions typically require several years of experience working with Medicare. The amount of experience needed depends on the level of the desired position, but applicants must undertake jobs that teach them how to process claims, judge the compliance of state programs and write reports about the results. Workers can substitute a master's or doctoral degree in a relevant field of study, such as business or healthcare administration, or combine education and experience to meet the requirement.

Step 3: Advance to Medicare Auditor

Depending on their level, Medicare auditors may have different job descriptions. Duties typically include auditing state programs for compliance issues and making appropriate changes, developing regulations for Medicaid programs and contractors and recommending improvements to Medicare operations. As auditors gain experience, they may teach Medicaid regulations to other staffers or lead program analysis teams.

Success Tip:

  • Consider a graduate or professional degree program. Medicare auditing jobs are available to those who hold a high school diploma and those who have earned a bachelor's degree or completed other postsecondary education, provided these individuals also have significant experience working for the U.S. government. In some cases, a professional or graduate degree in law, business, healthcare administration or public administration can be substituted for some of this experience.
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Average Salaries for Auditors: Wage and Salary Information

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Source: Bureau of Labor Statistics