What is the difference between medical officer and medical auditor?

Certified medical auditors, also known as compliance auditors, perform 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, also known as compliance auditors, perform 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.

The Chief Medical Officer is a key member of the Senior Executive team, engaged in defining the overall business strategy and direction of the organization. In addition, this position leads the overall clinical vision for the organization and provides clinical direction to the Health Management, Network, Product and Credentialing divisions. The position provides medical oversight, expertise and leadership to ensure the delivery of affordable quality healthcare services. Responsibilities also include the strategy, development and implementation of innovative clinical programs that include collaboration with strategic business partners.

The key differences:

Medical auditing is a critical piece to compliant and profitable physician practices. Whether it's RAC audits, private payer denials, or just peace of mind, more physicians plan to have audits conducted regularly. The risks of being non-compliant with documentation and coding are too great. As a CPMA, you will be able to use your proven knowledge of coding and documentation guidelines to improve the revenue cycle of nearly all healthcare practices. While medical officer  position will require the employee to handle Protected Health Information (PHI) for duties related to provider credentialing, complaints and grievances, claims issues, Medical Management issues and risk and compliance issues. Access to the PHI contained in the claims, Medical Management and provider credentialing systems is necessary for this staff member.

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