Become a Medicare Auditor

Medicare auditors or Recovery Audit Contractors (RACs) help find discrepancies or errors in payments made to Medicare providers. If you want to become a Medicare auditor, you will need a degree, a few years of experience, and certification. You can apply directly for a government job through the Centers for Medicare and Medicaid Services (CMS) or you might find a job through a private company. If you advertise yourself as a ethical worker with strong computer skills, you may just get your perfect job as a Medicare auditor.

Steps

Meeting the Requirements

1. Get an associate's or bachelor's degree. You need at least an associate's degree to get a job as a Medicare auditor in most states, but a bachelor's degree will improve your chances. While no specific degree is required, degrees in finance, nursing, health administration, or health information management are ideal.
2. Earn experience in medical billing. While it may be possible to become a Medicare auditor without prior training, most positions require a few years experience with medical auditing, billing, or coding. Experience working for the government may also help your application.
   • To get experience, you can work for medical accounting firms, insurance companies, a private practice, or CMS itself.
   • If you cannot find work in medical billing, you may want to find a job that requires data entry or analysis instead.
   • You can also look for internships with CMS, the Department of Health and Human Services (HHS), the Social Security Administration (SSA), or nonprofit groups such as the Center for Medicare Advocacy.
3. Gain certification as a Medical Audit Specialist. Most positions require or recommend certification from at least one recognized national organization, such as the American Association of Professional Coders (AAPC) or the American Association of Medical Audit Specialists (AAMAS).
   • To be certified by the AAPC, you need to join their association and take an exam. To renew your certification, you will need to take 36 continuing education credits every two years.
   • To be certified by AAMAS, you need at least two years of experience in auditing as well as 60 college credits in math, statistics, accounting, and finance. You will need to pass an exam to get your certification.

Finding a Job

1. Research who oversees Medicare audits in your region. The government hires private companies to handle medicare audits for them. Which company you can apply to depends on where you live. Check the CMS website to see which region you belong to.
   • Region one is overseen by Performant Recovery, Inc.
   • Regions two and three are handled by Cotiviti, LLC.
   • Region four is operated by HMS Federal Solutions.
2. Check for job listings from major medical and insurance companies. Insurance companies, hospitals, and other medical corporations may hire a Medicare claims auditor to review their internal Medicare claims. Your job would be to check and correct any discrepancies that might cause a problem with the government.
   • To find job listings, you can check the website of major corporations or look at job boards, networking websites, and employment agencies.
3. Rewrite your resume to emphasize your auditing experience. Make sure that your resume highlights your experience in medical billing, data entry, or healthcare. If you don't have much experience in these areas, emphasize soft skills, like attention to detail, critical thinking, or problem solving skills.
   • Any skills with medical billing software should be noted. State which programs you have experience with.
4. Interview for the job. If the company likes your resume, you may get an interview. They will likely ask questions about your experience, communication skills, and problem solving skills. Some questions they may ask include:
   • What problems have you faced as a medical auditor in the past?
   • Have you ever discovered fraud? How did you deal with it?
   • What other relevant experience do you have in healthcare?
   • How do you keep up with changes in Medicare regulations?
   • How well do you work with others?

Developing a Strong Skillset

1. Learn Medicare codes and regulations. As a Medicare auditor, you must understand all Medicare practices, as well as any new laws or regulations. Stay in touch by reading professional newsletters. You can even attend conferences for medical billers and professional coders.
   • Always read CMS's yearly reports to Congress to understand the latest developments.
   • CMS hosts all their guidance manuals online. Paper copies are also available.
2. Refine your computer skills. Medicare auditors must work with a variety of medical billing services and software. While you will be provided with the software that you need, you should stay up to date with various technological developments in medical billing.
   • It is important that you are familiar with popular medical billing programs, such as Meditouch and Kareo, so that you can comb through records more easily.
3. Demonstrate ethical standards. Medicare auditors must protect the privacy of the patient and doctor. For this reason, you may have to prove you are trustworthy. Any past criminal or legal conflicts may limit your job opportunities in this field.
   • To prove that you are ethical, you can try asking a former employer to submit a character reference as part of your job application.

Tips

• Talk to Medicare auditors about what they like about their jobs and how they entered the career field. They might have advice and information that would be hard to get elsewhere.

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• Become a Medicare Consultant

References

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