Certified Health Care Auditor: Education and Career Roadmap

Learn how to become a certified health care auditor. Research the job description, education, and certification requirements to find out how to start a career in medical billing and coding. View article »

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Video Transcript

Certified Health Care Auditors

Since the passage of the Health Insurance Portability and Accountability Act (HIPAA) in 2006, the health care industry has developed new ways to meet legislative compliance requirements. Certified health care auditors are integral to successfully meeting these demands.

Career Requirements

Certified health care auditors have:

Degree Level Associate's degree
Degree Field Medical billing and coding
Experience 3 years experience before advanced credentialing
Licensure and Certification RHIT credential from AHIMA
Key Skills Data entry, regulatory compliance, statistics, auditing skills, risk analysis, and quality assurance methodology
Salary (2015) $37,110 per year (Median salary for medical records and health information technicians)

Source: U.S. Bureau of Labor Statistics

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Be a Certified Health Care Auditor

What steps do I need to take to be a certified health care auditor?

Step 1: Earn an Associate's Degree in Medical Billing and Coding

A working knowledge of medical billing and coding is necessary to properly audit health care records. Coding specialists work within a standardized classification system using diagnostic codes to classify patient data. Medicare, Medicaid, and other health insurers reimburse medical offices based on this data. Many 2-year colleges offer associate's degree programs in medical billing and coding. Besides general education courses, students looking to gain familiarization with medical coding and billing expect to study courses in:

  • Basic anatomy and physiology
  • Medical terminology
  • Collections
  • Ethics and medical law

Step 2: Obtain Your RHIT Credential

The American Health Information Management Association (AHIMA) offers the Registered Health Information Technicians (RHIT) credential. An RHIT is certified to verify the accuracy of electronic medical records, provide data analysis, and code diagnoses and procedures for both research and reimbursement purposes. A degree from a 2-year program accredited by the Commission on Accreditation for Health Informatics and Information Management (CAHIIM) is required to sit for this examination.

Step 3: Gain Three Years of Career Experience

Certified technicians in billing and coding have employment opportunities in doctor's offices, hospitals, outpatient treatment facilities, and insurance companies. According to the U.S. Bureau of Labor Statistics (BLS), job openings for medical records and health information technicians will increase 15% in the years from 2014-2024, which is much faster than the average outlook for other careers.

Step 4: Acquire Your Advanced Credentials

Available after three years of work experience, the Certified Coding Specialist (CCS) designation is also offered by AHIMA. A CCS has advanced skills in records review, the International Classification of Diseases Ninth Revision (ICD-9-CM) and Current Procedural Terminology (CPT) classification systems, and possesses additional expertise in pharmacology and disease processes. For more specific needs of a physician's practice, the CSS-P designation is also offered.

Another licensing body, the American Association of Professional Credentialing (AAPA), offers the Certified Professional Medical Auditor (CPMA) designation. Health care auditors with this certification are qualified in regulatory compliance, statistics, auditing skills, risk analysis, and quality assurance methodology. An associate's degree and two years of professional experience are recommended before sitting for this exam.

Step 5: Specialize as a Health Care Auditor

Certified health care auditors find employment in a variety of health care settings, including hospitals, physicians' practices, outpatient care centers, and nursing care facilities. Outside the health care industry, auditors are needed anywhere patient data exists, such as pharmaceutical companies, insurance companies, billing and coding companies, or in federal government agencies.

Certified health care auditors have associate's degrees and certification. They are skilled in data entry with a thorough knowledge of regulatory compliance, auditing, and quality assurance methodology, and they earn a median annual salary of $37,110.

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