Medical Auditor

Posted Date 06 Nov 2023



Experience Icon Experience 2 Years Salary Salary 5000AED
Job Type Icon Job Type Full Time Company Company NMC Healthcare
Job Category Icon Job Category Medical Qualification Icon Qualification BS pharmacy
Gender IconGender Both Date Last Date 26 Dec
Vacancies IconVacancies 1 Remote IconRemote No
Location Location(s) Abu Dhabi , United Arab Emirates

Description Job Description


  • Review and⠀Audit⠀Medical⠀Claims to⠀ensure⠀their⠀accuracy.
  • Resubmission⠀of⠀rejected⠀claims
  • 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.

DUTIES AND RESPONSIBILITIES :

  • Review and⠀Audit⠀Medical⠀Claims to⠀ensure⠀their⠀accuracy.
  • Resubmission⠀of⠀rejected⠀claims
  • 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.

QUALIFICATION, LICENSURE, EDUCATION, EXPERIENCE, SPECIAL SKILLS :

  • Medical/paramedical⠀(Nursing,⠀pharmacy,⠀etc.)⠀graduate⠀from a⠀recognized⠀university⠀preferred.
  • Experience⠀in⠀Insurance⠀Claims⠀management/adjudication⠀(minimum 2⠀years)
  • Experience⠀in Medical⠀Coding is⠀preferable.
  • Excellent⠀command of⠀oral and⠀written⠀English

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