Medical AuditorR/Research Officer at DEDA Hospital

JOB DESCRIPTION

• Reviewing insurance claims for accuracy, including reviewing medical records for documentation of services rendered and items supplied
• Conducting onsite audits of hospitals, clinics, nursing homes, home health agencies, or other facilities to ensure that they are adhering to safety standards and ethical guidelines
• Assisting patients with filing appeals or grievances with their insurance companies regarding coverage or payment issues
• Making recommendations to improve patient care based on findings of the audit
• Reviewing and analysing data to identify possible areas of concern or risk to patients
• Conducting internal audits to ensure compliance with federal regulations such as Medicare guidelines
• Reviewing clinical documentation to determine whether or not it meets established standards of care
• Conducting audits of pharmacies to ensure that medications are dispensed properly and accurately
• Conducting routine audits of insurance claims to ensure that they have been processed correctly
• Review medical records to ensure that documentation meets all requirements for billing and coding 
• Identify errors in documentation and work with providers to correct them Educate providers on proper documentation techniques Stay up-to-date on current coding guidelines and regulations
• Ensure that claims are submitted in a timely manner and meet all deadlines
• Verify that claims have been processed correctly and appeal any denied claims
• Review provider contracts to ensure that billing and coding comply with the terms of the agreement
• Prepare reports on audit findings and present them to management
• Develop and implement policies and procedures related to billing and coding
• Train new staff members on billing and coding procedures
• Participates in all claims audit with HMO and cooperate organization to ensure full recovery of all forms
• Prepare medical reports for all HMO patient management cases for either OPD or inpatient
• Respond to queries and enquiries from HMO and cooperate organization on patient management
• Will prepare supporting documents and reports for disputes and queries on patient management from HMO and cooperate organizations
• Participate in preparing and reviewing SOP of the Department.
• Serve as a resource to other departments on billing and coding issues
• Perform other duties as assigned
• Research and come up with contents (written/videos) for publications on all social media handles, journals, blogs, website and other Deda channels
• Serve as the main medical research, manager for the hospital on a monthly basis, giving feedback to management through report on new development and best practices in patients management and hospital administration
• Perform any other adhoc duties

REQUIRED QUALIFICATION &SKILLS:

• MBBS, Registration with relevant bodies.
• Attention to details: Find enlarged lymph nodes or splenomegaly on examination
• Effective communication: Explain a disease or procedure to patients in plain, understandable terms.
• Problem solving Skill: Recognize when a patient needs to be transferred to the ICU.
• Ability to work in a team: Know when to call in a consultant and when to do the work themselves.
• Ability to handle pressure
• Display patience
• Strong understanding of Generally Accepted Auditing Standards (GAAS)
• Proficient in Microsoft Office, with advanced Excel skills
• Excellent analytical, research, and problem-solving skill