Medical Review Doctor

3 days ago


Riyadh, Saudi Arabia ACCUMED Full time

Medical Review Doctor is responsible for identifies incomplete documentation that could affect a healthcare facility by examining the coding procedures and ensuring the organization complies with regulatory requirements. A Medical Review Doctor would be expected to identify fraudulent claims, outliers, reimbursement deficiencies, inefficiencies, incorrect codes and poor documentation.
**Responsibilities**
- Performs inpatient, ambulatory surgery, emergency room, outpatient and evaluation/management coding audits on the team members work
- Provide remote colleague educational sessions on issues identified during the audit process
- Responsible for providing billing compliance education to all physicians and advanced practice practitioners within the division
- Provide feedback of audit findings to physicians and conduct post-audit training sessions as audit results
- Supervising and processing the In-Patient approvals
- Medical and policy adjudication of admitted cases in the visited hospitals based on the medical data and investigations reports in the patient’s file and the medical discussion with the treating doctor if necessary (Approve/Reject)
- Ensuring that the correct current procedural terminology, or CPT, and international classification of disease, or ICD-9, codes are used
- Determine if reported medical claims are fraud or process error, which required looking into physical claims, batch analysis, statements review, personal visits to the provider to inspect hospital records, and placing phone calls on suspected claims

**Requirements**:

- Educational background: Degree in Medicine is Must
- Medical Coding Certification is preferable
- 10+ years experience in KSA insurance and provider billing market
- Medical Billing Knowledge with certification will be as well an added advantage

**Benefits**
- Private Health Insurance
- Paid Time Off
- Training & Development
- Performance Bonus


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