Insurance Claim Auditor Ahmedabad Doctors - MediEnsure Pvt Ltd

MediEnsure Pvt Ltd

Verified Company

Ahmedabad, India

2 weeks ago

Posted by:

Deepika Kaur

beBee Recuiter

Description

Greetings From MediEnsure Pvt Ltd

Job Title:
Hospital Auditor

Primary Role:

As a hospital auditor, the primary role is to evaluate medical claims made by hospitals to ensure that they are medically necessary and accurately billed based on the policies and protocols of the health insurer.

They also play a key role in identifying and preventing fraudulent claims by cross-referencing multiple claims and reviewing medical records in detail.

Responsibilities:

The primary responsibilities of a hospital auditor are:

Conduct audits of medical claims submitted by hospitals to ensure accuracy and appropriateness.
Verify the medical necessity of procedures and treatments performed on patients.
Identify and report fraudulent billing practices.
Evaluate compliance with industry regulations, such as HIPAA and Medicare/Medicaid standards.
Analyze medical records to determine if the care provided meets industry standards and best practices.
Prepare reports to present audit results to hospital management and health insurer leadership.
Communicate with hospital staff and physicians to ensure that they are aware of the audit process and any changes to policies or procedures.
Provide support and guidance to hospital staff to help them understand industry regulations and billing practices.
Monitor and evaluate trends in claims data to inform policy changes and improve the overall efficiency and effectiveness of the health insurer's operations.

Qualifications:
The qualifications required for a hospital auditor working for a health insurer are:

Bachelor's degree in health care management, finance or related field.
Knowledge of medical billing codes and insurance industry standards.
Ability to read and interpret medical records and claims documents.
Experience conducting audits and reviewing financial statements.
Excellent analytical skills and attention to detail.
Excellent communication skills, both written and verbal.
Ability to work independently and within a team environment.
Understanding of healthcare industry regulations and quality improvement standards.
Proficiency in using computer and data analysis software.