Job Description

Officer, Medical Audit/ Payment Integrity ( UAEN)

Main Duties
Billing and Payment Review Audits: Conduct simple to medium in-house audits of billing, trend, and report irregularities to ensure accuracy, compliance with policy terms, coding standards, and regulatory requirements. Prepare the Logic and collaborate with the data analytic team for logic scripting and analyse the received data for accurateness and improvement needs.
Provider Collaboration: Engage with healthcare providers to clarify billing practices, ensure compliance, and streamline audit processes.
Explore new areas to improve cost and quality in healthcare system: Collaborate with External and Internal stakeholder for improvement initiative, e.g., initiation of a guideline and implement policies and procedures related to billing review/audit and collaborate with BUs to improve cost and quality in healthcare system.
Process Improvements: Always monitor the related processes, procedures, and guidelines and identify the areas of strength and weakness to help the department become more effective and efficient. Implementation of changes as required including updating of Policy and Procedure Manuals, Templates, Workflows, and other documents once deemed necessary to align them with industry standards and regulatory guidelines.

Work Experience Requirements
3+ years of experience in medical claims auditing, payment integrity, healthcare compliance, or a similar role within the insurance or healthcare industry.
Licensure / Certification Requirements

Coding or auditing certifications highly desired
Licensed clinicians also advantageous

Education
Bachelor degree in Medicine, Healthcare Administration, Business, or related field.

Skills & Competencies
Good knowledge of healthcare regulations, ethical standards, and auditing best practices.
Proficiency in healthcare billing and coding practices, understanding of claims processing systems, and familiarity with medical terminology.
Strong analytical skills with the ability to interpret complex claims data and identify discrepancies or irregularities.
Excellent communication, collaboration, and negotiation skills to interact effectively with diverse stakeholders.
Proven track record in developing and implementing policies, conducting audits, and driving process improvements.
Respect and maintain a high-level confidentiality
Proactive and results oriented whilst ensuring high quality of work
Good level knowledge of Microsoft applications