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Nurse Auditor Certification and Certificate Program Info

Nurse auditors combine their knowledge of medical procedures with an understanding of medical billing and coding systems to guarantee accurate billing and reimbursement. There are no formal nurse auditor programs, however, certification is available.

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Essential Information

Experienced registered nurses interested in nurse auditor certification may apply to the American Association of Clinical Coders and Auditors (AACCA). The AACCA is the only non-profit, industry-standard organization in the United States offering certification for nurse auditors. They also offer study aids, test preparation materials and continuing education opportunities. The certification exam is administered online and test results are available immediately upon completion (www.aacca.net). Applicants to this program must be a licensed registered nurse with one year of medical coding.


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Certification Programs in Nurse Auditing

These professionals must have a broad range of knowledge to perform their appointed tasks. They must be knowledgeable of healthcare institution services and policies, medical treatments and terminology, and the latest in insurance and governmental guidelines and regulations. Below are listed some core components covered by the nurse auditor certification exam:

  • Chart audits
  • Diagnostic coding guidelines
  • Medical fraud and abuse
  • 3rd-party reimbursement
  • Coding operative reports

Employment Outlook and Salary Information

Payscale.com shows a median salary for nurse auditors in January 2016 of $64,520. Meanwhile, the U.S. Bureau of Labor Statistics' median salary for all nurses was $67,490 in 2015. While the BLS doesn't provide employment outlook specifically for nurse auditors, it does report that registered nurses overall should enjoy a 16% increase in jobs over the 2014-2024 decade, which is faster than the average for all occupations.

Certificate Programs and Continuing Education Information

There are no stand-alone certificate programs for nurse auditors. Individuals interested in becoming a nurse auditor must first complete an accredited nursing program. Then, once nursing licensure is obtained, individuals gain the needed coding and billing experience by working at a healthcare facility. In this way, the career path of nurse auditor is open only to experienced professional nurses. It is not an entry-level position.

Because of the ever-changing nature of healthcare rules and regulations, nurse auditors may find it advantageous to enroll in continuing education courses. These courses can provide knowledge and insight into topics such as changes in Medicare and Medicaid reimbursement and other medical coding issues. In addition to its other services, the AACCA offers continuing education courses on a range of coding, auditing and billing topics.

Registered nurses already working in the healthcare field who are proficient in topics such as chart audits, diagnostic coding guidelines, and 3rd-party reimbursement, may wish to take the AACCA exam in order to become a nurse auditor.

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