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Medical Claims Auditor
Full time at a Laimoon Verified Company in Abu Dhabi, UAE

Medical Claims Auditor Full time at a Laimoon Verified Company in Abu Dhabi, UAE

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Posted on March 15, 2018

Job details

• Conduct data-driven audits of healthcare claims, checking and evaluating accurately the medical record and related documents of the members to assess any discrepancy in the billing of services or in regards to the justification of the procedure(s). 

• The Medical Claims Auditor identifies, develops, and implements new concepts that will recognize incorrect payments; 

• External Auditing the IR-DRG Claims and Out-Patient Claims ; Pre-Approval claims auditing IR-DRG claims & Inpatient EClaims (Dubai) ;  Visits hospitals and major providers to conduct spot audits and raise the findings and detect ;

• He / She will analyze claims and highlight any specific trends; report the same based on ICD 10,  CPT guidelines & UAE's health authorities requirements; such as DHA and/or ;

 Responding the queries (un-bundling code, up-coding, medically justify) ; Other Medical Coding queries from Network Department & IT ; 

Reports: Auditing, Price-list Comparison, Pre-Audit Analysis report, Drug Code list comparison report, 

Requirements:  

• Medical Coding Certification (Certified by AHIIMA / AAPC from ) 

• Medical Background preferred ;

• Hospital coding experience for 3-5 years is an advantage ( IP & OP).

• DRG experience , Ability to understand complex oral and written directions, and technical ;

• High decision-making ability and ability to work under pressure.

• Assertive with good communication, negotiation, presentation and interpersonal skills

• Good command of written and spoken English, knowledge of Arabic would be an added advantage.

• Good knowledge of Microsoft applications especially excel and analytical software.

• Ability to operate effectively with people at all levels of the business.

• Good analytical, planning, execution, documentation and conflict solving skills

Sound and up-to-date medical knowledge.

• Strong interpersonal skills that will support collaborative team work.

Other benefits

Annual ticket ; life and medical covers.

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