How to Become a Medicare Auditor

Medicare auditors are also called Recovery Audit Contractors (RACs), and the position is a relatively new one. The Centers for Medicare and Medicaid Services (CMS) employs these contractors and auditors to help find discrepancies or errors in payments made to Medicare providers. Because Medicare is such a large government program, there is a lot of risk for fraud and waste, and Medicare auditors help to limit that. Become a Medicare auditor by getting a college degree, gaining experience and earning the necessary state license and national certification.


  1. Image titled Become a Medicare Auditor Step 1
    Get a degree. A minimum of an Associate's degree is necessary to find work as a Medicare auditor in every state. A Bachelor's degree will increase your chances of getting hired.
    • Major in any field. While there is no specific degree for an auditor or a Medicare professional, an educational background in finance, business or health administration will help.
    • Take classes in healthcare law, statistics, math, business, accounting and insurance law.
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    Complete an internship. Doing an internship in the auditing or healthcare fields will help prepare you for a career as a Medicare auditor.
    • Look for auditing internships with accounting firms in your area. You can also look for internships specific to Medicare with agencies such as CMS, the Department of Health and Human Services (HHS), the Social Security Administration (SSA) or nonprofit groups such as the Center for Medicare Advocacy.
  3. Image titled Become a Medicare Auditor Step 3
    Obtain training and experience. As a Medicare auditor, you will be responsible for reviewing claims, patient records and hospital and physician billing practices.
    • Look for jobs that will give you experience as a healthcare or medical auditor. You can work for accounting firms that have medical clients, work in the finance or business offices of a healthcare provider or try to get a job with CMS directly.
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    Get your state license. In order to work as a Medicare auditor in a specific state, you will need to be licensed by that state.
    • Expect to take an exam, meet educational requirements and in some cases, take continuing education classes. All states have different licensure requirements, but an exam and continuing education are standard in most states.
  5. Image titled Become a Medicare Auditor Step 5
    Become certified as a Medical Audit Specialist. This certification is not required, but will demonstrate an additional level of professionalism and training that sets you apart from other auditors.
    • Contact the American Association of Medical Audit Specialists ( for certification requirements and information. You will need at least 2 years of experience as a healthcare auditor to qualify for certification.
    • Demonstrate coursework for your certification through AAMAS. You will need to have 60 college credits in classes such as math, statistics, accounting and finance. You will need to pass an exam to get your certification.
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    Keep your computer skills up to date. Medicare auditors will be required to work on site at different medical and healthcare establishments. You will need to use a laptop and any specific software you are provided for audits.
    • Get to know all the available medical billing programs. Each office you visit will have a different way of maintaining their invoices, charts and records.
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    Expect an hourly wage with bonuses for any money you recover as a result of finding financial discrepancies in Medicare billing. The amount of your hourly rate will depend on the state you work in. The average in 2011 is $29.66 per hour.
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    Demonstrate ethical standards. You will have access to a lot of confidential patient and billing information. Any past ethical or legal conflicts will limit your ability to work as a Medicare auditor.
  9. Image titled Become a Medicare Auditor Step 9
    Get a job with one of the organizations that contracts Medicare auditors. Depending on the state and region you live in, you will need to apply through a specific company that Medicare uses.
    • Identify your area as Region A, B, C or D and then apply to Diversified Collection Services (Region A), CGI (Region B), Connolly, Inc (Region C) or Health Data Insights, Inc (Region 4). Visit for information on your region and the Recovery Audit Contracting program.


  • Talk to Medicare auditors about what they like about their jobs, and how they entered the career field. They might have advice and information that would be hard to get anywhere else.
  • Stay up to date on changes and developments in Medicare. The law is constantly changing, and you will need to have access to the most recent legal and regulatory information as an auditor. You can get updates from CMS and sign up for weekly or monthly e-newsletters.

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Categories: Careers in Government