Medical Quality & Audit Officer (Dentist) at QLM

QLM; Doha; Vor Ort; QAR 167.000 - 279.000; Vollzeit

Zusammenfassung

QLM in Doha, DAW, QA, is hiring a Medical Quality & Audit Officer (Dentist) for a full-time, on-site role. You will conduct provider field audits, review claims, and ensure policy compliance across Qatar.

The candidate should hold a Dentistry degree with 3–5 years in health insurance or medical audit, possess strong ICD-10/CPT/DRG coding knowledge, and be able to guide junior teammates while traveling as needed.

Qualifikationen

• Bachelor's degree in Dentistry is required.
• 3–5 years in health insurance, medical audit or claims management.
• Strong knowledge of ICD-10, CPT, and DRG coding.
• Experience in provider audits and medical claims review.
• Excellent analytical, investigative, and report-writing skills.
• Proficient in Microsoft Office and EMR systems.
• Willing to travel within Qatar for provider field audits.

Aufgaben

• Conduct provider field audits and clinical documentation reviews.
• Review medical claims and pre-approvals for coding accuracy, medical necessity, and policy compliance.
• Identify billing irregularities, fraud, waste, and abuse indicators.
• Prepare audit reports, document findings, and communicate with healthcare providers.
• Manage audit cases from initiation through completion.
• Support recovery, reconciliation, and quality improvement initiatives.
• Guide and support Senior Associates during audit activities.
• Ensure compliance with internal policies, audit standards, and regulatory requirements.

Kenntnisse

Analytical skills

Investigative skills

Report writing

Travel willingness

ICD-10/CPT/DRG

Claims review

Dentistry background

Ausbildung

Bachelor's degree in Dentistry

Tools

Microsoft Office

EMR systems

Jobbeschreibung

Apply for Medical Quality & Audit Officer (Dentist) at QLM in Doha, DAW, QA.

This Full time on site position offers great opportunities for career growth.

Job description

Company Description

QLM Life and Medical Insurance is the largest health insurance provider in the State of Qatar, offering specialized services tailored to meet the diverse needs of the community. The company leads the health insurance sector with innovative and flexible insurance programs designed to suit individuals and organizations. QLM is recognized for its commitment to excellence and superior customer service. It provides advanced solutions to ensure comprehensive coverage and support for its members.

Role Dimensions

The successful candidate will be responsible for conducting provider audits, reviewing medical claims, identifying billing discrepancies, and ensuring compliance with insurance policies and regulatory requirements. This role also supports audit reporting and provides guidance to junior team members.

Key Responsibilities

• Conduct provider field audits and clinical documentation reviews.
• Review medical claims and pre-approvals for coding accuracy, medical necessity, and policy compliance.
• Identify billing irregularities, fraud, waste, and abuse (FWA) indicators.
• Prepare audit reports, document findings, and communicate with healthcare providers.
• Manage audit cases from initiation through completion.
• Support recovery, reconciliation, and quality improvement initiatives.
• Guide and support Senior Associates during audit activities.
• Ensure compliance with internal policies, audit standards, and regulatory requirements.

Requirements

• Bachelor's degree in Dentistry.
• 3-5 years of experience in health insurance, medical audit, clinical review, or claims management.
• Strong knowledge of ICD-10, CPT, and DRG coding.
• Experience in provider audits, medical claims review, and healthcare documentation.
• Good analytical, investigative, and report-writing skills.
• Proficiency in Microsoft Office and healthcare claims/EMR systems.
• Willingness to travel for provider field audits within Qatar.

If you have a strong clinical background, audit experience, and are passionate about improving healthcare quality, we encourage you to apply.

Pay: QAR1.00 - QAR2.00 per month

Work Location: In person