Transguard Careers UAE – Senior Officer Clinical Audit

Job Description:

Transguard Group was established in 2001 and has diversified significantly, we lead in the fields of Cash Services, Security Services, Manpower Services, Facilities Management & Aviation. Transguard Group is the UAE’s most trusted business support and outsourcing provider and has a large, dynamic and culturally diverse workforce with 50,000 employees! We are currently recruiting for a Senior Officer- Clinical Audit (Medical Provider Audit) for our client to be based out of their Abu Dhabi office.

Job Responsibilities:

• Assists the Manager in issuing monthly audit recoveries
• 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.
• Prepares monthly remote and on-site Audit Plans.
• 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.
• Interprets medical information such as disease or symptoms, and diagnosis descriptions and procedures for a given visit in order to accurately assign and sequence the correct ICD 9/10 CM and CPT codes.
• Ensures to justify with documents and billing rules the stand formulated on coding related disputes with Provider.
• 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.

Job Requirements:

• CPC/CPMA
• Full Professional Proficiency in English language

Qualification & Experience:

• Requires 3 to 5 years of relevant experience
• Minimum Bachelor’s Degree either in medicine or dentistry /paramedic/ healthcare industry

Job Details:

Company: Transguard

Vacancy Type:  Full Time

Job Location: Dubai, UAE

Application Deadline: N/A

Apply Here

Jobaric.com