Medical Auditor

Abu Dhabi, United Arab Emirates

Job Description

:
  • Apply medical knowledge and best insurance practice while auditing / reviewing the claims prior submission, medical records and other documentation essential to justify the services rendered to the patient by the healthcare facility.
  • Ensure that the details of the claims are in line with the regulators\' standards especially the claim adjudication Rules and Business Rules.
  • Handling resubmission of rejected claims.
Responsibilities:
  • Review and Audit Medical Claims to ensure their accuracy.
  • Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
  • Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
  • Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
  • Submit the claims with proper codes and format to insurance companies within the stipulated time
  • Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
  • Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements
  • Work accordance with the documented OSH procedures and instructions, specific responsibilities
  • Be familiar with emergency and evacuation procedures
  • Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports
  • Comply with Waste management procedures and policies
  • Attend applicable OSH/Infection control training programs, mock drills and awareness programs
  • Use of appropriate personal protective equipment and safety systems
Qualifications:
  • Medical/paramedical (Nursing, pharmacy, etc.) graduate from a recognized university.
  • Experience in Insurance Claims management/adjudication (minimum 2 years)
  • Experience in Medical Coding is preferable.
  • Excellent command of oral and written English.

NMC Healthcare

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Job Detail

  • Job Id
    JD1724932
  • Industry
    Not mentioned
  • Total Positions
    1
  • Job Type:
    Full Time
  • Salary:
    Not mentioned
  • Employment Status
    Permanent
  • Job Location
    Abu Dhabi, United Arab Emirates
  • Education
    Not mentioned