Auditor | Daman National Health Insurance Company
A well-known and well-reputed Company based in Dubai, United Arab Emirates is looking for an experienced, skilled, competent, mature, qualified, creative, and intelligent candidate with significant knowledge and relevant working experience for the position of “Auditor”.
Company Name |
Daman National Health Insurance Company |
Qualification | Bachelors Degree |
Experience | 2 – 4 years of Relevant Experience Required |
Monthly Salary | 5,500 AED – 7,000 AED |
Employment Type | Full Time | Permanent |
Company Size | 50-100 Employees |
Benefits | Medical Insurance |
Location | Dubai |
Job Title : Medical Auditor
Our ideal candidate meets the following requirements:
– 1+ years of clinical experience and 1 year of work experience in any of the medical units of a health insurance company or third party administrator (TPA),or
– 2+ years of experience in a medical unit of a health insurance company or third party administrator
– Experience in medical coding and clinical documentation
– Experience in Statistical Sampling methodologies is preferred
– Medical coding certification such as CPC (AAPC), CCS, CCA (AHIMA), etc. is preferred
– Bachelor’s Degree in Medicine
Advantage if you have:
– Good command of written / spoken English; knowledge of Arabic language
– Good knowledge of health insurance concepts
– Sound and up-to-date medical knowledge
– Medical and billing record auditing skills
– Knowledge of medical documentation and clinical coding (ICD 9, CPT, DRG, USCLS, etc.) preferred
– Knowledge of health insurance fraud/abuse and law/compliance regulation
– Knowledge of statistical sampling methodologies
Major responsibilities:
– Conduct data driven on-site audits of healthcare service providers, checking and evaluating accurately the medical record and related documents of the members to assess any discrepancy in the billing of services or regarding the justification of the procedure(s).
– Investigate suspected health insurance misuse and abuse cases related to Daman members, collect necessary documentation and evidence to support the evaluation of the case.
– Prepare final audit report following the on-site audit and investigation; communicate with the providers regarding the audit findings and initiates the corrective adjustments, if any.
– Study all policies and procedures relevant to the providers; liaise regularly with all relevant departments to understand current provider issues and status.
– Understand local provider market and study statistical analysis of provider behavior prepared by Daman’s MSD department, commission specific data analysis required by audit.
– Keep abreast and ensure that all audit activities comply with the legal requirements. pertaining to auditing of providers in the Emirate of Abu Dhabi and the U.A.E.
– Ensure that business decisions and processes are documented in a professional manner.
– Offer technical support by ongoing assessment of data quality and proper service encoding.