Medical Auditor

NMC Group; Abu Dhabi; On-site; AED 60,000 - 90,000; Full time

Job summary

NMC Group in Abu Dhabi is seeking an Administration professional to review and audit medical claims, resubmit rejected claims, and ensure compliance with payer pricing and provider manuals. The role requires timely updates to billing officers and coordination with doctors for justified resubmissions.

The ideal candidate holds a medical or nursing degree with experience in insurance claims resubmission and a preference for knowledge in medical coding, along with excellent English communication

Qualifications

• Medical/Nursing graduate from a recognized university.
• Experience in Insurance Claims Resubmission.
• Experience in Medical Coding is preferable.
• Excellent command of oral and written English.

Responsibilities

• Review and audit medical claims to ensure their accuracy.
• Resubmission of rejected claims.
• Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
• Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.
• Handling the resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
• Submit the claims with proper codes and format to insurance companies within the stipulated time.

Skills

English proficiency

Education

Medical/Nursing graduate from a recognized university

Job description

3.1 Review and AuditMedical Claims to ensure their accuracy.

3.2 Resubmission of rejected claims

3.4 Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers

3.5 Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future

3.6 Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.

3.7 Submit the claims with proper codes and format to insurance companies within the stipulated time.

Responsibilities

• Review and AuditMedical Claims to ensure their accuracy.
• Resubmission of rejected claims
• Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers
• Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
• Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
• Submit the claims with proper codes and format to insurance companies within the stipulated time.

Qualifications

• Medical/Nursing graduate from a recognized university.
• Experience in Insurance Claims Resubmission
• Experience in Medical Coding is preferable.
• Excellent command of oral and written English.

Job Info

• Job Identification 8773
• Job Category Administration
• Job Schedule Full time
• Locations NMC Mesk AlMadina, Abu Dhabi, AE