Medical Auditor - #24839

JOB SUMMARY: 2.1 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. 2.2 Ensure that the details of the claims are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules. 2.3 Handling resubmission of rejected claims.
3. DUTIES AND RESPONSIBILITIES: 3.1 Review and Audit Medical Claims to ensure their accuracy. 3.2 Resubmission of rejected claims 3.3 Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers. 3.4 Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future 3.5 Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission. 3.6 Submit the claims with proper codes and format to insurance companies within the stipulated time.3.7 Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title. 3.8 Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements 3.9 Work accordance with the documented OSH procedures and instructions, specific responsibilities 3.10 Be familiar with emergency and evacuation procedures 3.11 Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports 3.12 Comply with Waste management procedures and policies 3.13 Attend applicable OSH/Infection control training programs, mock drills and awareness programs 3.14 Use of appropriate personal protective equipment and safety systems

4. QUALIFICATION, LICENSURE, EDUCATION, EXPERIENCE, SPECIAL SKILLS:

4.1 Medical/paramedical (Nursing, pharmacy, etc.) graduate from a recognized university. 4.2 Experience in Insurance Claims management/adjudication (minimum 2 years) 4.3 Experience in Medical Coding is preferable. 4.4 Excellent command of oral and written English