Q&A: Training HIM staff to better navigate audits

Q: As payer analytics become more sophisticated, what specific skills or training should HIM professionals pursue to keep pace with evolving audit techniques?

Gina Stewart, MBA, BSN, RN, CCS, CCDS, vice president of coding quality and education at e4health: As payer analytics continue to advance, evolving audit techniques are becoming increasingly complex and difficult to understand. These methodologies can feel overwhelming, even for experienced professionals, and can easily create confusion if teams try to master every technical detail. The goal isn’t for HIM professionals to become experts in payer algorithms. Rather, they should strive to remain aware of and informed about audit technique initiatives, trends, and shifts that may impact coding, documentation, or claim validation.

With that awareness in mind, HIM professionals should focus on expanding and growing their knowledge base in practical, targeted ways. Foundational training in data literacy, denial trending, and clinical reasoning helps staff interpret how payers might flag anomalies in claim data. Understanding basic data analysis concepts—such as identifying outliers, recognizing documentation risk signals, or interpreting pattern-based reviews—empowers teams to anticipate payer focus areas without needing deep technical expertise.

Cross-functional learning is also invaluable. As payer audits increasingly integrate medical necessity, quality measures, and utilization patterns, coders and CDI specialists benefit from developing broader insight into risk adjustment data validation methodologies, Office of Inspector General audit priorities, and clinical validation logic. By combining awareness of emerging audit tactics with practical analytical and clinical reasoning skills, HIM professionals strengthen their ability to adapt, communicate risk clearly, and help their organizations stay one step ahead of payer scrutiny.

Editor’s note: This Q&A was excerpted from our HIM Briefings newsletter.