Nurse Auditor Career Guide
How to Become a Nurse Auditor
If you’re a registered nurse, then you already know you have a lot of options when it comes to career progression. But have you ever thought about becoming a nurse auditor? Nursing auditors are experienced nurses with a background in coding insurance claims. Their job is to assist patients by ensuring accurate billing and claims.
What Is a Nurse Auditor?
A nursing audit consists of collecting information from nursing reports, medical notes and other patient care records to help assess the quality of care. Therefore, a nurse auditor is responsible for managing medical records in healthcare settings and insurance companies. They make sure that everything is following correct processes and systems—from quality of care and medical necessity to regulations, complaints, and insurance claim coding. While a lot of people get into nursing to provide healthcare for their patients, nurse auditors can gain satisfaction from providing patients with financial care and making sure they get everything they’re entitled to.
What Does a Nurse Auditor Do?
A nurse auditor’s job is to oversee medical records and make sure that everything is coded correctly, ensuring optimal outcomes for both the patient and the hospital. Below is a summary of just some of the day-to-day tasks they might be asked to perform.
Managing medical records and insurance claims. The cornerstone of a nurse auditor’s job is managing the medical records at their place of employment. They’ll be analyzing files and running them through rigorous checks: was the procedure undertaken by the patient a medical necessity? Did the patient receive the correct quality of care that they should have? Have they filed the insurance claim correctly? And will that claim be covered or not?
Ensuring accuracy and compliance with various regulations. Accuracy of medical records is paramount—and in a chaotic environment like a hospital, people can easily make mistakes. That’s why a nurse auditor must go through everything with a fine-toothed comb and ensure a high level of accuracy. Plus you’ll have to make sure that everything complies with hospital, state, and insurance regulations.
Appeals and billing. Medical billing is a complicated process. It all depends on the patient, the insurance, and the procedure. Nurse auditors are responsible for ensuring that this complicated process is done correctly. Plus any errors in medical coding can mean money lost by the hospital. So working accurately, staying up to date on coding rules, and verifying insurance policies will keep this extra cost to a minimum. And if something does go wrong, you’ll be the one they call upon to sort it out.
How Do I Become a Nurse Auditor?
Step One: Become a Registered Nurse.
The first thing you’ll have to do is become a Registered Nurse (RN). You’ll need a nursing diploma, associate degree, or a bachelor’s degree in nursing in order to become licensed in your state. If you already have a nursing diploma or an associate degree in nursing, you might want to apply for an RN-to-BSN, which allows working nurses to gain their bachelor’s faster. A BSN is usually especially valuable for those who want to move beyond being a registered nurse into other roles, like nurse auditing. So pursuing your BSN is key to progression.
Step Two: Obtain Medical Coding and Experience.
While there’s no specific degree required to be a nurse auditor, being an RN is a must; and BSN can be extremely helpful in ensuring you stand out from other candidates. And once you’ve got that, you’ll need to gain some experience with coding and billing in a healthcare setting. You can do this at a hospital, hospice, or a medical clinic. You’ll want around one year of experience before you begin the certification process and become a nurse auditor.
Step Three: Gain Nurse Auditor Certification.
The final step is getting certified. While there are several routes you can take, the American Academy of Professional Coders (AAPC) offers training to help you pass the exam, additional study materials, and lots of advice. The exam covers topics such as chart audits, third-party reimbursement, and medical fraud. And once you’ve successfully obtained your certification, you’ll be ready to start your new career as a nurse auditor.
Best Degrees for a Nurse Auditor
Nursing (Prelicensure) – B.S.
A one-of-a-kind nursing program that prepares you to be an RN...
A one-of-a-kind nursing program that prepares you...
A one-of-a-kind nursing program that prepares you to be an RN and a baccalaureate-prepared nurse:
- Locations: Due to in-person clinical requirements, students must be full time residents of FL, IN, TX, MO, ID, IA, KS, OH, NM, NV, or UT to enroll in this program. The coursework in this program is offered online, but there are in-person requirements.
- Tuition: $6,430 per 6-month term for the first 4 terms of pre-nursing coursework, $8,755 per 6-month term for the remaining 4 terms of clinical nursing coursework.
- Time: This program has a set pace and an expected completion time of 4 years. Certain coursework may be accelerated to finish faster.
- WGU offers the prelicensure program in areas where we have partnerships with healthcare employers to provide practice sites and clinical coaches to help teach you and inspire you on your path to becoming a nurse.
- If you don't live in one of our prelicensure states or don't qualify to apply, consider getting our Bachelor's in Health and Human Services instead. This degree allows you to work inside the healthcare industry, while also working directly with patients who need help.
College of Health Professions
Nursing – Leadership and Management (RN-to-MSN) – M.S.
This program for RNs includes a BSN component and is a...
This program for RNs includes a BSN component and...
This program for RNs includes a BSN component and is a substantial leap toward becoming a nurse leader.
- Time: 75% of RN-to-MSN grads finish within 42 months.
- Tuition: $4,685 per 6-month term during undergraduate portion; $4,795 per 6-month term during graduate portion.
Some careers and jobs this degree will prepare you for:
- Director of Nursing
- Chief Nursing Officer
- Quality Director
- Clinical Nurse Leader
- Project Manager
If you're driven to lead, this online nursing degree will provide you everything needed to make that career a reality.
Compare degrees
This program is not the only degree WGU offers designed to create leaders in the field of healthcare. Compare our health leadership degrees by clicking the button below.
College of Health Professions
Nursing Leadership and Management – Post-Master's Certificate
A certificate for registered nurses with a master's degree in...
A certificate for registered nurses with a...
A certificate for registered nurses with a master's degree in nursing who are ready for greater responsibility in a leadership and management role.
- Time: 12 months.
- Tuition and fees: $4,795 per 6-month term. The cost to sit for the NAHQ Certified Professional in Healthcare Quality (CPHQ) exam is included in tuition.
Sample careers and jobs this degree program will prepare you for:
- Director of Nursing
- Chief Nursing Officer
- Quality Director
- Clinical Nurse Leader
- Project Manager
The Bureau of Labor Statistics projects employment of medical and health services managers to grow 17% by 2024, much faster than the average for all occupations.
College of Health Professions
Nursing (RN-to-BSN Online) – B.S.
An online BSN degree program for registered nurses (RNs) seeking...
An online BSN degree program for registered...
An online BSN degree program for registered nurses (RNs) seeking the added theoretical depth, employability, and respect that a bachelor's degree brings:
- Time: 66% of graduates finish within 18 months.
- Tuition: $4,685 per 6-month term.
- Transfers: On average, students transfer 81 credits.
With over 35,000 BSN alumni, this is one of WGU's most popular online degree programs. View our RN to BSN degree guide.
If you don't currently have an RN and don't qualify for your nursing prelicensure program, consider getting our Bachelor's in Health and Human Services instead. This degree allows you to work inside the healthcare industry in a unique way.
College of Health Professions
Nursing – Leadership and Management (BSN-to-MSN) – M.S.
For registered nurses with a bachelor's degree who are ready for...
For registered nurses with a bachelor's degree...
For registered nurses with a bachelor's degree who are ready for greater responsibility:
- Time: 82% of grads finish within 24 months.
- Tuition: $4,795 per 6-month term.
Sample careers and jobs this degree program will prepare you for:
- Director of Nursing
- Chief Nursing Officer
- Quality Director
- Clinical Nurse Leader
- Project Manager
The Bureau of Labor Statistics projects employment of medical and health services managers to grow 17% by 2024, much faster than the average for all occupations.
Compare degrees
This program is not the only degree WGU offers designed to create leaders in the field of healthcare. Compare our health leadership degrees by clicking the button below.
College of Health Professions
Our Online University Degree Programs Start on the First of Every Month, All Year Long
No need to wait for spring or fall semester. It's back-to-school time at WGU year-round. Get started by talking to an Enrollment Counselor today, and you'll be on your way to realizing your dream of a bachelor's or master's degree—sooner than you might think!
What Skills Does a Nurse Auditor Need?
A nurse auditor needs a wide array of skills to thrive in the workplace. First of all, they must be highly-trained registered nurses with a deep understanding of the latest medical practices and insurance systems. And on top of that, they’re auditors with an eye for detail and numbers, making sure no mistakes slip by them. This requires:
- Great communication skills
- Knowledge of medical coding systems
- Attention to detail
- Keen understanding of insurance plans
- The ability to work as part of a team
How Much Does a Nurse Auditor Make?
$63,200
What Is the Projected Job Growth?
7%
Data from the BLS states the Registered Nursing (RN) sector will experience a 7% growth during the 2019-2029 period. That’s 221,000 more registered nurses. But there’s still a lack of capacity to meet this growing demand. This is being driven partly by the healthcare needs of baby boomers as they get older, and the growing urgency of healthcare reform in the United States.
Where Do Nurse Auditors Work?
Remote
With advancements in healthcare software and technology, many nurse auditors have found they’re able to work from home. Most of their job involves scrutinizing records and submitting reports, so there’s no real need for them to be in the hospital. As long as you’re experienced and reliable, many employers seem willing to trust you to get the job done from home.
Nurse Auditor FAQ's
What is a nurse auditor?
A nurse auditor is an individual responsible for managing medical records in healthcare settings or for insurance companies. They audit charges and claims and make sure that everything is following correct processes and systems—from quality of care and medical necessity to regulations, complaints, and insurance claim coding.
What job can I do after nursing?
If you’re looking for a change from nursing, you might consider looking into an adjacent career. Some potential career choices that, depending on your background and experience, you might be able to move to include: charge audit nurse, medical records and health information technician, pharmaceutical sales, nutritionist, health educator, administrative services manager, medical and health service manager, clinical social worker, speech-language pathologist, nurse educator, social worker, clinical manager, director of case management, clinical documentation specialist, nursing quality improvement coordinator, or clinical informatics specialist.
What does a medical chart auditor do?
Medical charge auditors review medical records for billing and insurance purposes, quality and accuracy with an eye towards measuring care so that it can be improved.