How do I Become a Nurse Auditor?

A nurse auditor is a healthcare professional who reviews medical records to ensure they meet insurance billing requirements. Nurse auditors also review claims for accuracy and compliance with Medicare regulations.

In some cases, nurse auditors may also train staff to document patient care properly. The role of the nurse auditor is crucial as it helps ensure that healthcare providers are reimbursed for their care.

In addition, by catching errors and providing training, nurse auditors help improve the overall quality of healthcare documentation. As such, they play an essential role in the healthcare system.

Steps to Becoming a Nurse Auditor

According to career counselors at Jooble job aggregator, nurse auditing can be an excellent occupation if you like to work with numbers and enjoy detail-oriented work. Nursing auditor positions are usually entry-level, so it can be a perfect way to start your career in the medical field.

Nursing auditor positions usually require a bachelor’s degree in nursing or accounting. They also need strong math skills and attention to detail. The job typically involves reviewing patient charts and ensuring that all charges are accurate.

Nurse auditors may also be responsible for auditing billing procedures and insurance claims. To begin with, some of the skills you will need to have include;

  • A Deep Understanding of Medical Coding Systems

This is the way of converting medical diagnoses and procedures into code numbers. Healthcare providers use those systems to submit insurance claims and track patient records.

The most common medical coding system in the United States is the ICD-10, which was replaced by the ICD-11 on Jan 1st, 2022. The ICD-10 consists of over 120,000 codable terms that are all digitally available.

The coding system is used by doctors, hospitals, and insurance companies to diagnose and treat patients. Nurse auditors need a deep understanding of medical coding systems since one of their duties is reviewing medical records to ensure correct codes.

They also use coding systems to identify potential errors and fraud. Without a deep knowledge of medical coding systems, nurse auditors would be unable to do their job effectively.

  • Strong Math Skills

Nurse auditors need strong math skills because they often have to calculate reimbursement rates. They also use math when reviewing medical bills to ensure that the correct charges are applied.

In addition, nurse auditors often have to calculate statistical data. For example, they may need to calculate the percentage of patients correctly diagnosed with a certain condition. Without strong math skills, nurse auditors would be unable to do their job effectively.

  • Attention to Detail

Nurse auditors must be detail-oriented because they are responsible for reviewing medical records. They must pay attention to every detail to identify errors and potential fraud.

In addition, nurse auditors often have to compare medical records to billing statements. This requires them to pay close attention to both documents to identify discrepancies.

  • Strong Writing Skills

Nurse auditors must have strong writing skills because they often must prepare reports. In some cases, they may also have to give presentations.

Strong writing skills are essential because nurse auditors must communicate their findings clearly and concisely. If their reports are difficult to understand, it could lead to errors.

Now that you know the skills needed, the next big concern is how actually to become a nurse auditor. Well, there are three basic steps;

  • Become a Registered Nurse
  • Get your Medical Coding and Experience
  • Obtain the Nurse Auditor Certification
  1. Becoming a Registered Nurse

To become a nurse auditor, you must first become a Registered Nurse (RN). You can get a nursing diploma, an associate degree, or a bachelor’s degree in nursing.

Once you are licensed in your state, you may want to consider getting an RN-to-BSN. This will allow you to gain your bachelor’s degree faster. Pursuing your BSN is key to progression if you want to move beyond being a registered nurse into other roles, such as nurse auditing.

  1. Getting your Medical Coding and Experience

After becoming an RN, you will need to get experience in medical coding. This can be done by working as a coding specialist or a coding auditor.

You will also need to have experience in auditing. You can accomplish that by working as an internal auditor at a hospital or an insurance company.

III. Obtaining the Nurse Auditor Certification

The final step to becoming a Certified Nurse Auditor is passing the AAPC exam. With their training, study materials, and advice, you will be more than ready to take on this new career.

The exam tests your knowledge of chart audits, third-party reimbursement, medical fraud, etc. Once you have passed, you will be able to start your new job as a nurse auditor on Jooble!

In Closing

Becoming a nurse auditor may sound daunting, but it is well worth it in the end. You will be able to help hospitals and insurance companies save money while also protecting patients. Becoming a nurse auditor may take some time and effort, but you will be glad you did it!