Medical Insurance Auditor

Job Summary

Audit different Departments based on the request of HOD with regard to compliance and Guidelines of Insurance Companies. Audit the process of Approvals and Billing according to the guidelines of Insurance Companies. Create awareness sessions for Doctors and guide them with regard to the Rejections of Insurance Companies.

Major Duties and Responsibilities

• Medical insurance auditor is responsible to identify fraudulent claims, outliers, reimbursement deficiencies, inefficiencies, incorrect codes and poor documentation to improve the organization being challenged by the insurance companies.
• Study the rejections of the various services received from the various companies, either direct or insurance companies and create awareness sessions for doctors.
• Provide al the medical details/documents to the company section so as to enable them to prepare the monthly billing for the various contracted companies.
• Audit the various medical documentation including Medical Reports, OR Reports, and UCAFs. Identify errors submit it back to doctors for corrections before Claims Submission and Coordinate with business Center and train the Physicians.
• Monitor the work of medical coders and billers, identifies incomplete documentation that could affect a healthcare facility's livelihood by examining the coding procedures and ensuring the organization complies with regulatory requirements.
• Assist in updating the hospital price list.
• Prepares the financial/medical details for the various package procedures which are offered to hospital clients.
• Study the contract of the various insurance companies/direct companies and advice the Finance Department about any unfavorable clauses.
• Prepares the code for the excluded services for computerization.
• Performs additional tasks and duties as assigned by Superiors

Reporting to

• Director General

Qualifications:

• Post graduate qualification in any medical specialties is preferred.

A minimum of:

• Five (5) years work of experience after M.B.B.S. or 3 years after obtaining the post graduate qualifications
• Previous experience of dealing with the health insurance providers.
• Good medical knowledge so as to discuss various issues with insurance companies (Medical/Administrative/Contractual).
• Good command over English knowledge both written and oral.