Jan 20, 2020
Medical Claims Auditor Vacancy in Dubai
Working independently, or within a team, the Medical Claims Auditor performs all activities related to data mining, claims analysis, and auditing.
Possess strong knowledge of CPT, ICD, HCPCS, DRG coding and claims adjudication for medical claims.
Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations.
Reviews the medical claims for Inpatient and outpatient billing.
Check eligibility and benefits verification for treatments, hospitalizations, and procedures.
Perform audits targeting and evaluating procedural diagnosis code selection.
Checking insurance payments for accuracy and compliance with contract.
Conduct independent data mining and data analysis utilizing claims data.
Identify incorrect coding, fraudulent claims and present audit findings.
Identify and recommend policy, procedure and system changes to enhance investigative outcomes and performance.
Review claims according to the HAAD and DHA rules and coding guidelines.
Assign codes to diagnoses and procedures, using ICD and CPT codes.
Prepare reports and presentations.
Assist in implementation of auditing system.
Reviews that pricing is correctly applied.
Reviews medical necessity.
Strong analytical and qualitative skills as well as problem solving skills with the ability to look for root causes and implement workable solutions.
UAE experience is mandatory in Dubai or Abu Dhabi region.
Knowledge of the principles and practices of medical auditing.
Must have a track record of producing high quality work that demonstrates attention to detail.
Proficiency in Microsoft Office applications (Word, Excel and Power Point).
Ability to travel and be on-site as needed for audits.
Strong Interpersonal skills with the ability to work in a fast paced environment whether as a team member or an independent contributor.
Prefer individual possessing any of the following certifications or licensure: CFE, RN, CPC, or CPMA.
Knowledge of coding, reimbursement and claims processing policies.
Knowledge of medical terminology.
Location: Dubai or Abu Dhabi
Remuneration: According to skills and experience.
Interested candidates can send their CV