Certified Professional Medical Auditors (CPMA)
A certified medical auditor, also known as a compliance auditor, performs audits and reviews of clinical documents, physician billing records, administrative data, and coding records. They ensure compliance with industry regulations and maintain quality assurance.
Certified medical auditors, like other types of auditors, usually work full-time, during business hours. Auditors usually work independently, though some collaboration with other auditors, medical office managers, or accountants might be necessary. They operate in an office setting and might travel to the locations of the medical offices they are auditing.
A career as a medical auditor will require a bachelor's degree in business, medical records technology, health services administration, nursing, or a related field. Potential employers will likely be looking for someone with three to five years of experience in a coding or a clinical position. This career also requires certification as a Registered Health Information Administrator (RHIA), Certified Medical Auditor Specialist (CMAS), Certified Coding Specialist (CCS), or a Certified Professional Coder (CPC).
Some of the key skills an individual may find necessary to work in this field are: strong communication, analytical and organizational skills and excellent writing and speaking skills. The ability to maintain confidentiality and the ability to work independently or in a team environment will be beneficial. Medical auditors should also have knowledge of Medicaid and Medicare, HIPAA and JCAHO / TJC regulations, an understanding of CPT and ICD coding processes, medical terminology and experience with MS Word, Excel, and data entry.
CPMA Certification: Steps
Prospective CPMAs will need to earn a bachelor's degree and gain experience on their way to earning certification.
Step 1: Earn a Relevant Bachelor's Degree
Several acceptable education paths allow one to become a certified medical auditor. A bachelor's degree program in business, health services administration, or related administrative field can help prepare students for their careers in medical auditing. This type of degree program in business administration may provide coursework in a variety of useful topics such as accounting and finance, business laws, anatomy and physiology, and operations management.
A health services administration degree program might provide coursework in health economics, health administration, management and organizational behavior, managed care and related topics.
Degrees in nursing would provide a more clinical-based education that can be applied to a career in medical auditing.
Step 2: Pursue Medical Auditing Experience
Most employers require candidates to have three to five years of experience in coding, nursing, or a healthcare compliance position. An entry-level healthcare administrative position or clinical nursing experience can be useful when looking for employment as a medical auditor. Candidates should have a strong knowledge base in medical terminology, coding processes, and healthcare laws and regulations before seeking a position as a certified medical auditor.
Step 3: Earn a Medical Auditor Certification
There are a number of different kinds of certification for medical auditors, such as the:
- Registered Health Information Administrator (RHIA)
- Certified Coding Specialist (CCS)
- Certified Medical Audit Specialist (CMAS)
- Certified Professional Medical Auditor (CPMA)
Registered Health Information Administrator (RHIA)
Many certifications are accepted by employers for a certified medical auditor position. The American Health Information Management Association, (AHIMA) offers an RHIA designation that shows competency in health information and records management and knowledge of medical ethics and law. Requirements include graduation from an accredited bachelor's degree program in a healthcare-related field.
Certified Coding Specialist (CCS)
The CCS designation shows competency in medical coding and billing practices and knowledge of medical terminology, disease processes and other related topics. Requirements vary and include previous RHIA certification, one to two years of coding experience or completion of a coding education program. Both certification programs require passing a written examination.
Certified Medical Audit Specialist (CMAS)
The American Association of Medical Audit Specialists (AAMAS) offers a CMAS designation that demonstrates an auditor's professional integrity and knowledge. Requirements include two years of experience in healthcare claims auditing, completion of an accounting, finance or related education program or experience as a licensed healthcare professional. Applicants must become members of the AAMAS to apply. Applicants must pass a written examination to become certified.
Certified Professional Medical Auditor (CPMA)
The American Academy of Professional Coders (AAPC) offers a CPMA examination that gives medical auditors certification. The exam costs $399 and involves 150 multiple choice questions. The AAPC suggests that those wanting to have this certification have at least two years of experience in the field, though no other specific requirements exist.
Medical Auditor Salary
The website Payscale.com reports that the median salary for medical auditors was $53,000 as of April 2020. The United States Bureau of Labor Statistics does not report specifically on a medical auditor or coding auditor salary, but it did report that all accountants and auditors earned a median annual income of $71,550 as of May, 2019. The BLS also reported 4% job growth for accountant and auditor jobs between 2019 and 2029.
Becoming a medical auditor requires an individual to have earned a bachelor's degree in a business administrative or a healthcare field and the ability to become certified in order to perform duties that may include medical coding, review of documents, data entry, knowledge of healthcare regulations, and other abilities related to auditing like maintaining confidentiality and working both independently and with others in a professional setting.