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Medical Auditor

  • Job
    Full-time
    Mid & Senior Level
  • Data
    Healthcare
  • Dubai

AI generated summary

  • You need a Bachelor's in Nursing, Coding, or a paramedical degree, experience in healthcare or insurance, fluency in English, and MS Office skills. Arabic is a plus.
  • You will submit, analyze, and resubmit hospital and pharmacy claims, manage billing in ERP/Oracle, communicate rejections, and report on claims metrics and outstanding amounts.

Requirements

  • Bachelors Degree (Preferred Nursing, Coding or paramedical degree) with experience in Insurance or healthcare industry
  • Fluent in spoken and written English. Spoken Arabic is advantageous but not essential.
  • Sound Knowledge in MS Office.

Responsibilities

  • Submission of Hospital and Pharmacy Claims within the due date as per Insurance Contractual terms and conditions.
  • Analyzing the rejected Claims and resubmission of the same within due date.
  • Segregates Finalized IP and OP Bills in HIS as per Insurance Company.
  • Creates Insurance wise XML Claims Batches and submits the same to DHPO.
  • Receives the bills from Pharmacy for PBM and Non PBM Claims, Verifies the same and confirms it in ERP/Oracle.
  • Creates Insurance company wise XML batches for Pharmacy Claims and Submission of Non PBM claims in DHPO.
  • Analysis Rejected Claims and resubmits the same in DHPO with appropriate justification.
  • Communicates about rejections received to various teams concerned.
  • Provides report of no of claims generated, submitted, amount received, claims cost, outstanding.

FAQs

What are the primary responsibilities of a Medical Auditor in this role?

The primary responsibilities include submission of hospital and pharmacy claims, analyzing rejected claims for resubmission, segregating finalized bills, creating insurance-wise XML claims batches, verifying pharmacy bills, and communicating about rejections to various teams.

What qualifications are preferred for this position?

A Bachelor's Degree is preferred, particularly in Nursing, Coding, or a paramedical field, along with experience in the insurance or healthcare industry.

Is fluency in languages required for this position?

Fluent spoken and written English is required, and spoken Arabic is advantageous but not essential.

What software skills are necessary for the role?

Sound knowledge of MS Office is necessary for the position.

How does the Medical Auditor handle rejected claims?

The Medical Auditor analyzes rejected claims and resubmits them to the designated authority (DHPO) with appropriate justification.

What type of claims does the Medical Auditor work with?

The Medical Auditor works with hospital claims, pharmacy claims (both PBM and Non PBM), and performs submissions based on insurance contractual terms.

What kind of reports does the Medical Auditor provide?

The Medical Auditor provides reports on the number of claims generated, submitted, amount received, claims cost, and outstanding claims.

Is there an emphasis on teamwork within this role?

Yes, the Medical Auditor communicates rejections to various teams, which emphasizes the importance of teamwork in resolving claim issues.

What is the expected work environment for this job?

The work environment is expected to be in a healthcare or insurance setting, with potential for hybrid remote work options.

Are there any specific tools or systems used for claims processing in this role?

Yes, the Medical Auditor uses systems like ERP/Oracle for verifying pharmacy bills and handles XML claims batches for processing.

Delivering personalised care that matters.

Science & Healthcare
Industry
10,001+
Employees
1974
Founded Year

Mission & Purpose

NMC Healthcare is one of the largest private healthcare networks in the United Arab Emirates, and the third largest in Oman. Since 1975, we have provided high quality, personalised, and compassionate care to our patients and are proud to have earned the trust of millions of people in the UAE and around the world. ---------------------------------------- DISCLAIMER: Fraudulent Job Offers ---------------------------------------- It has come to our attention that fake job offers have been circulated under the name of NMC Healthcare by certain individuals/entities claiming that they are representatives or subsidiaries or under contract with NMC Healthcare. If you receive any unauthorised, suspicious, or fraudulent offers or interview calls, please send an email to verification@nmc.ae for formal verification. If you believe you have been a victim of a recruitment fraud, you are encouraged to approach the law enforcement agencies immediately.