Clinical Audit Senior Officer Jobs in Dubai | Transguard Careers

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Description:

To execute strategies under guidance of Manager to sample, analyse, identify and audit medical (including dental where relevant) claims to reduce fraud, wastage, abuse or errors (FWAE) from providers. Makes best use of tools made available for analytics and research to detect and control cases while ensuring smooth operations including compliance with insurance policies and set company standards, procedures and guidelines and provisions of regulatory bodies and Provider Contracts.

Job Responsibilities:

• Follows medical audit operational procedures, Insurance Policies, Regulator guidelines Policy on fraud and abuse, and monitors their adherence so that work is carried out in a controlled manner.
• Develops and updates procedures manuals to maintain standards for correct coding, minimize the risk of fraud and abuse, and optimize revenue recovery.
• Performs day-to-day operations of remote and on-site Audit of medical / dental claims to detect misuse/abuse/fraud/errors and ensure that work processes are implemented as designed and comply with established standards and procedures and desired recoveries/ results are achieved.
• Evaluates medical records documentation to ensure the diagnostic and procedural codes accurately reflects and supports the reason for encounter and to ensure that data comply with legal standards and guidelines.

Job Requirements:

• Minimum Bachelor’s Degree either in medicine or dentistry /paramedic/ healthcare industry
• CPC/CPMA
• Requires 3 to 5 years of relevant experience
• Full Professional Proficiency in English language