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

Mar 05, 2020

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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Should I Become a Medicare Auditor?

Degree Level High school diploma; bachelor's degree or higher for advancement
Degree Fields Business, finance, law, healthcare administration, or 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; experience with claims processing software
Salary $78,820 (2018 average for accountants and auditors)

Sources: U.S. Bureau of Labor Statistics, Center for Medicare & Medicaid Services, ONet Online, U.S. Department of Labor Statistics

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

As such, these auditors generally need strong critical thinking, decision making and problem solving skills. Most Medicare auditors are employed full-time. The job requires little physical activity, and such auditors work in an office setting. They must be excellent communicators and work well as part of a team, as well as with the public.

How much do these workers make? According to the U.S. Bureau of Labor Statistics, auditors and accountants in the federal government earned an average annual salary of $100,080 as of May 2018, which is among the highest earnings for these professionals compared to other industries.

Step 1: Consider College

For many, earning a degree is the first step to a career in Medicare auditing. Some Medicare auditors only need a high school diploma or the equivalent. 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 bachelor's degrees in business, finance, law or a field related to insurance or healthcare. These degree programs may provide relevant training in research, finance, health insurance and healthcare law.

No matter which major you choose, it's essential to develop strong oral and written communication skills, which are helpful in collecting information from Medicare recipients and collaborating with other departments. Courses in mass communication, English and public speaking can strengthen these skills.

Here's a tip for success: Complete an auditing internship 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 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 provide relevant training in processing claims, judging the compliance of state programs and writing reports about the results. Keep in mind that workers may substitute experience with a master's or doctoral degree in a relevant field of study or combine education and experience to meet the requirement. With that in mind, you may want to consider attending graduate school to advance your career. Common topics of graduate study among Medicare auditors include law, business, healthcare administration and public administration.

Step 3: Advance to Medicare Auditor

With experience and expertise, these workers can gain promotion to an auditing position. 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 be responsible for teaching Medicaid regulations to other staffers and leading program analysis teams.

A high school diploma and several years of experience working with the federal government are the minimum requirements for a career as a Medicare auditor, though formal education can serve as a substitute for experience.

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