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.