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BASIC DESCRIPTION
A medical records auditor audits, examines, verifies, adjusts, and corrects medical records and bills to ensure accuracy and consistency. They report discrepancies to personnel and ensure corrective action is taken in a timely manner. They audit physician billing practices against documentation in the medical record to ensure compliance with all federal, state, and third-party billing requirements, rules, and regulations. Medical records auditors go through medical records to make sure everything is in compliance and all the codes match up for billing purposes.
EDUCATIONAL REQUIREMENTS
Registered nurse preparation is required. Many facilities also prefer that the applicant has some college-level business courses or health care experience.
CORE COMPETENCIES/SKILLS NEEDED
■ Strong analytical skills and some basic training skills to teach people how to correct problems
■ A basic knowledge of diagnostic-related groups and coding
■ A broad knowledge of disease processes, findings, courses of treatment, quality assurance, and risk management are essential
RELATED WEB SITES AND PROFESSIONAL ORGANIZATIONS
■ National Committee for Quality Assurance (www.ncqa.org/)
■ Agency for Healthcare Research and Quality (www.ahrq.gov/)
■ National Association for Healthcare Quality (www.nahq.org/)