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What Does a Clinical Auditor Do?

Wanda Marie Thibodeaux
Wanda Marie Thibodeaux

A clinical auditor's job is to investigate the operations, documentation and billing procedures of a medical facility to find and fix problems that hinder patient care or create inefficiency. She works with management to develop fixes for any issues found. Once a strategy for modification is set, the auditor oversees its implementation and monitors the facility's progress over time. Other tasks such as peer review and the construction of formal reports are standard, as well.

One of the biggest responsibilities for a clinical auditor is the review of documentation, billing and procedures. As the auditor goes through the facility's paperwork, she checks for adherence to current regulations and company policies. She also analyzes factors such as data security and authorizations. The clinical auditor also looks at whether the current methods are up to industry standards or are taking too much time, space or money. As part of the review, the auditor might observe staff members as they work and talk with them to obtain or verify information.

A clinical auditor going over business receipts.
A clinical auditor going over business receipts.

Once the clinical auditor has information with which to work, she analyzes the data in-depth. She brainstorms about what the facility could do differently, taking into consideration factors such as the financial commitment necessary for each point of improvement. She also makes some projections about how the changes would statistically benefit the facility, which might involve doing additional research. From the view of managers, these projections are critical to accepting the ideas for improvement as sound and operationally viable.

Audits follow Accenting Rules & Regulations.
Audits follow Accenting Rules & Regulations.

Following analysis, the clinical auditor presents members of management with a formal audit report. She discusses the results with managers and presents her ideas for improvement, pointing out benefits and drawbacks of each concept or option. The discussion gives the managers the opportunity to respond to the analysis and explain which of the auditor's ideas will or will not work and why.

It also is the duty of a clinical auditor to develop formal training programs and clinical guidelines. The programs are designed to provide facility workers with the additional skills or information they need to improve service. The development of guidelines streamlines processes and reduces the opportunity for error, increasing accountability and the function of internal controls. In both program and guideline development, auditors must be specific, identifying particular deficiencies.

Some clinical auditors also conduct structured peer reviews. The purpose of these reviews is to provide constructive criticism that will make staff members aware of the problems present and which will motivate positive change. During this process, the auditors provide information that might benefit the staff. This data could be anything from performance statistics to descriptions of available courses.

Throughout the entire audit process, an auditor must keep records of everything she does and finds, including monitoring the progress of implementations. This shows how the auditor came to her conclusion and at what pace, which provides credibility. It also provides a record for reference for future audits.

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    • A clinical auditor going over business receipts.
      By: Arto
      A clinical auditor going over business receipts.
    • Audits follow Accenting Rules & Regulations.
      By: Nomad_Soul
      Audits follow Accenting Rules & Regulations.