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قام 181 شخص بالتقدم الى الوظيفة

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تاريخ الإعلان عنها: 2017/10/04 10:11:52
الرقم المرجعي JB1001851458
مشاركة   تغريد

National Health Insurance Company - Daman

Medical Auditor
National Health Insurance Company - Daman


الوصف الوظيفي

General Description:
Conduct medical audits of healthcare service providers on a regular basis and investigate suspected health insurance misuse and abuse

Main Duties:
• Conduct data driven on-site audits of healthcare service providers, checking and evaluating accurately the medical record and related documents of the members to assess any discrepancy in the billing of services or in regards to the justification of the procedure(s)
• Investigate suspected health insurance misuse and abuse cases related to Daman members, collecting necessary documentation and as required, evidence to support his/her evaluation of the case
• Ensure that business decisions and processes are documented in a professional manner with due confidentiality
• Prepare the final audit report following the on-site audit and investigation; communicate with the providers regarding the audit findings and initiates the corrective adjustments, if any
• Follow-up the recovery process related to the audited provider with Daman’s Claims department until completion
• Understand all policies and procedures relevant to the claims cycle and the auditing of providers, liaise regularly with all Daman departments involved in the claims cycle as well as the Provider Relations department to understand current provider issues and observed billing trends
• Understand the local provider market and understands statistical analysis of provider behavior prepared by Daman’s MSD department, commission specific data analysis as required by his/her audit plan
• Ensure that he is acquainted with the legal requirements pertaining to auditing of providers in the Emirate of Abu Dhabi and the U.A.E
• Offer technical support by continuous assessment and feedback concerning data quality and proper encoding of services
• Uphold the department’s goals and values, and contribute to its efficient development and growth
• Ensure that medical ethics and professionalism are maintained during the fulfillment of all tasks
• Support the company’s decisions and professionally represent Daman in Daman in aspects of dress code, punctuality, professionalism, etc.

المهارات

Bachelor Degree in Medicine
• At least 3 years work experience in the claims processing and adjudication department of a health insurance company or third party administrator (TPA), or
• At least 1 year work experience in the claims processing and adjudication department of a health insurance company or third party administrator (TPA) and at least 2 years clinical work experience, or
• At least 2 years work experience in an organization or company specialized in auditing of providers in the health care industry
• Experience in health insurance with knowledge of Health Insurance Fraud and Abuse is preferred
• Experience in medical coding and clinical documentation is preferred
• Experience in Statistical Sampling methodologies is preferred

• Good command of written and spoken English; knowledge of arabic language is an advantage
• Good analytical, execution, problem solving and decision making skills
• Ability to acquire and apply new skills
• Flexible and able to work under pressure
• Respect and maintain a high level confidentiality
• Proactive and results oriented whilst ensuring high quality of work
• Advance level of customer service orientation and professionalism in all interactions
• Able to work in a multi-cultural environment and promote teamwork and knowledge sharing in order to achieve goals and deliverables
• Good knowledge of health insurance concepts
• Good knowledge of Microsoft applications
• Sound and up-to-date medical knowledge
• Medical & billing record auditing skills is preferred
• Knowledge of medical documentation and clinical coding (ICD 9, CPT, DRG, USCLS, etc…) is preferred
• Knowledge of health insurance fraud and abuse is preferred
• Knowledge of health insurance law and compliance regulations is preferred
• Knowledge of statistical sampling methodologies is preferred

الخلفية التعليمية

Medicine

تفاصيل الوظيفة

  • منطقة الوظيفة: أبوظبي, الإمارات
  • قطاع الشركة: تأمين
  • المتطلبات : صاحب عمل (القطاع الخاص)
  • الدور الوظيفي: الطب
  • عدد الوظائف الشاغرة: 2

المرشح المفضل

  • المستوى المهني: مبتدئ
  • عدد سنوات الخبرة: الحد الأدنى: 3 الحد الأقصى: 6
  • الشهادة: بكالوريوس


وصف الشركة

Daman provides affordable quality healthcare solutions to suit your needs
Specialized Health Insurance services with an emphasis on customer care
The market leader with experienced staff that you can rely on.

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