Senior Medical Claims Auditor

Job details

Here’s how the job details align with your profile.

Pay

AED12,000 - AED14,000 a month

Job type

Full-time

Location

Dubai

Full job description

We are seeking a detail-oriented and analytical Medical Claims Auditor to join our growing team in Almadallah Healthcare. The ideal candidate will have extensive experience in medical billing, coding, and claims processing, with a strong ability to identify discrepancies, ensure accuracy, and uphold compliance with industry regulations. This role is crucial in ensuring our claims processes meet quality standards and minimize financial risk.

Key Responsibilities:

1. Perform audits on processed medical claims to ensure accuracy, proper coding, and adherence to company policies and regulatory guidelines.
2. Identify discrepancies, billing errors, and potential fraud, and provide recommendations for corrective actions.
3. Analyze trends in claims data to detect patterns and suggest process improvements.
4. Collaborate with claims processors, medical coders, and healthcare providers to resolve discrepancies and clarify medical records.
5. Develop and maintain detailed audit reports and present findings to management.
6. Ensure compliance with HIPAA, Medicare, Medicaid, and other relevant healthcare regulations.
7. Stay updated on industry best practices, coding guidelines (ICD-10, CPT, etc), and policy changes.
8. Assist in training and mentoring claims staff on quality standards and auditing procedures.

Qualifications:

1. Bachelor's degree in healthcare administration, finance, or a related field (or equivalent experience).
2. Minimum of 3 years of experience in medical claims auditing, medical billing, or healthcare administration.
3. Certified Professional Coder (CPC), Certified Medical Auditor (CPMA), or equivalent certification preferred.
4. Strong knowledge of medical terminology, coding (ICD-10, CPT), and healthcare reimbursement methodologies.
5. Excellent analytical skills and attention to detail.
6. Proficiency in claims processing software and Microsoft Office Suite.
7. Strong communication skills and the ability to present findings clearly and professionally.

Job Type: Full-time