Medical Officer – Clinical Audit
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.
• 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.
• 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.
For interested applicants, please send your CV at firstname.lastname@example.org