Officer, Medical Audit/ Payment Integrity ( UAEN)

Daman - National Health Insurance Company; Abu Dhabi; On-site; AED 120,000 - 200,000; Full time

Job summary

A leading insurance company in Abu Dhabi is seeking an experienced medical claims auditor to oversee billing practices and improve compliance. The role involves engaging with healthcare providers, conducting audits, and implementing policy changes to enhance efficiency. Ideal candidates will have strong analytical skills and a good understanding of healthcare regulations.

Qualifications

• 3+ years in medical claims auditing or healthcare compliance.
• Coding or auditing certifications highly desired.
• Licensed clinicians advantageous.

Responsibilities

• Conduct audits of billing and report irregularities.
• Engage with healthcare providers for compliance.
• Collaborate with stakeholders for process improvements.

Skills

Healthcare regulations

Auditing best practices

Analytical skills

Communication

Collaboration

Negotiation

Education

Bachelor degree in Medicine, Healthcare Administration, Business, or related field

Tools

Microsoft applications

Job description

Main Duties

• Billing and Payment Review Audits: Conduct simple to medium in-house audits of billing, trend, and report irregularities to ensure accuracy, compliance with policy terms, coding standards, and regulatory requirements. Prepare the Logic and collaborate with the data analytic team for logic scripting and analyse the received data for accurateness and improvement needs.
• Provider Collaboration: Engage with healthcare providers to clarify billing practices, ensure compliance, and streamline audit processes.
• Explore new areas to improve cost and quality in healthcare system: Collaborate with External and Internal stakeholder for improvement initiative, e.g., initiation of a guideline and implement policies and procedures related to billing review/audit and collaborate with BUs to improve cost and quality in healthcare system.
• Process Improvements: Always monitor the related processes, procedures, and guidelines and identify the areas of strength and weakness to help the department become more effective and efficient. Implementation of changes as required including updating of Policy and Procedure Manuals, Templates, Workflows, and other documents once deemed necessary to align them with industry standards and regulatory guidelines.

Work Experience Requirements

• 3+ years of experience in medical claims auditing, payment integrity, healthcare compliance, or a similar role within the insurance or healthcare industry.

Licensure / Certification Requirements

• Coding or auditing certifications highly desired
• Licensed clinicians also advantageous

Education

• Bachelor degree in Medicine, Healthcare Administration, Business, or related field.

Skills & Competencies

• Good knowledge of healthcare regulations, ethical standards, and auditing best practices.
• Proficiency in healthcare billing and coding practices, understanding of claims processing systems, and familiarity with medical terminology.
• Strong analytical skills with the ability to interpret complex claims data and identify discrepancies or irregularities.
• Excellent communication, collaboration, and negotiation skills to interact effectively with diverse stakeholders.
• Proven track record in developing and implementing policies, conducting audits, and driving process improvements.
• Respect and maintain a high-level confidentiality
• Proactive and results oriented whilst ensuring high quality of work
• Good level knowledge of Microsoft applications