Medical Claims Auditor

2 weeks ago

Makkah Al Mukarramah, Saudi Arabia ACCUMED Full time

A medical claims auditor, you will ensure that medical claims, medical records and other documentation essential to the healthcare industry are in compliance with CCHI and RCM industry standards. As a medical claims auditor, you'll have many responsibilities such as utilizing CPT, ICD-9 and other coding systems in the medical billing process; reviewing transcribed physician notes and contacting insurance agencies about claims. This means that you'll focus not only on processing medical claims, but also on making sure that those claims are processed accurately and according to CCHI standards. Some of your specific responsibilities may include detecting unlawful Medicare payments, conducting quality assurance assessments, reviewing statistical samples, filing financial data and reviewing third-party audits.
**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
- Determined 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**:
As a medical claims auditor, you'll need to rely on a range of analytical, technical and interpersonal skills to successfully complete most professional tasks. Some specific skills may include:

- The ability to match the information in medical records, such as diseases, with their proper codes
- The ability communicate patient data with other medical personnel
- The ability operate computerized coding technology
- The ability to pay strict attention to details
- The ability to follow instructions in precisely the manner in which they are laid out

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

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