Medical Officer - Clinical Audit
Full time
at a Laimoon Verified Company
in
Abu Dhabi, UAE
Medical Officer - Clinical Audit Full time at a Laimoon Verified Company in Abu Dhabi, UAE
Job highlights
Posted on June 11, 2018- Professional background in
- Job level Experienced
-
Pays salary of
AED 10,000 - AED 13,000 /month
(Fixed Salary) - Other requirements Male candidates only
Job details
Required for MNC in Dubai.
Medical officer - Clinical Audit will be responsible for conducting external Providers' audit on behalf of our Payers; will report concerns such as fraud or abuse as well as follow up on reconciliation of suspicious claims and ensure the practices adopted by providers are in line with HAAD and DHA guideline; He / She should ensure there is a medical necessity before settlement by Payers.
Job responsibilities:
• Evaluate the utilization trends of healthcare providers
• Evaluating the medical record of members to assess any discrepancy in the providers' billing of services and assessing medical necessity.
• Investigate suspected misuse and abuse cases related to members.
• Prepare the final audit report following the investigation; communicate the audit findings and initiates the corrective adjustments/actions, if any.
• Internally, follow-up on the recovery process related to the audited claims with Claims department until completion.
Candidate's qualification:
• Medical Background specifically MBBS degree holder.
• 2 Years Experienced with Inpatient/outpatient claims assessment is a distinct advantage coupled with ICD coding 10 and DRG experience are required.
• Certified Professional/Hospital Coder Certification is an advantage.
• Hospital's medical practitioner's for 2 years is a must.
• Highly assertive with good communication, negotiation, presentation and interpersonal skills.
• Ability to understand complex oral and written directions, and technical information.
• High decision-making ability and logical reasoning abilities.
• Able to work under pressure and varying schedules.
• Good command of written and spoken English, knowledge of Arabic or Hindi would be an added advantage.
• Good knowledge of Microsoft applications especially Advanced Excel & Analytical software.
Email at: vacancytpa
Other benefits
Annual ticket, medical and life insurance
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Show all questions(Your response will not be saved.)Hiring company
Confidential Company
The company has carved a unique niche in the regional healthcare sector because of its excellent service standards and innovative customer focused solutions. Through our various subsidiaries & affiliates, network agreements have been signed with more than 2,000 healthcare providers region-wide
No of employees: 201-500
Established in: 2002
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Hiring company
Confidential Company
The company has carved a unique niche in the regional healthcare sector because of its excellent service standards and innovative customer focused solutions. Through our various subsidiaries & affiliates, network agreements have been signed with more than 2,000 healthcare providers region-wide
No of employees: 201-500
Established in: 2002
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Child Psychology - Introduction Level Course LineAED 88Duration: Upto 3 Hours
-
Nursing Level 3 Course LineAED 88
AED 1,763Duration: Upto 13 Hours
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