Medical Auditor – Full time
Job Detail
We seek a highly qualified and experienced Medical Auditor to join our team. As a Medical Auditor, you will be responsible for reviewing medical records and claims to ensure that they meet established standards for medical necessity, coding accuracy, and compliance with applicable laws and regulations. You will work closely with insurance companies, third-party administrators (TPAs), and doctors to identify non-conformities.
 Responsibilities:
- Conduct medical record reviews to determine the medical necessity of services and the accuracy of coding and billing.
- Analyze claims data to identify trends and patterns related to nonconformities.
- Develop and implement audit plans and strategies to address identified risks and vulnerabilities.
- Provide education and training to doctors on coding and documentation requirements.
- Collaborate with internal and external stakeholders to promote compliance with applicable laws and regulations.
- Prepare and present audit reports and findings to management and external partners.
Requirements
- Medical degree from a recognized institution.
- Certified Professional Medical Auditor (CPMA) certification.
- Minimum of 3 years of experience in insurance companies or TPAs as a Medical Auditor or FWA specialist.
- Thorough understanding of medical coding and billing practices, including CPT, HCPCS, and ICD-10.
- Knowledge of healthcare laws and regulations, such as HIPAA.
- Excellent analytical, communication, and problem-solving skills.
- Ability to work independently and as part of a team.
- Strong attention to detail and accuracy.
Job Type: Full-time
Salary: Negotiable
WARNING: FRAUDULENT JOB OFFERS OR JOB POSTINGS
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Job seekers are advised to exercise caution and diligence when accessing websites related to employment opportunities to protect themselves from these criminal and fraudulent acts. In the event of a suspected incident of financial fraud, please report it to the relevant authorities. Within the United Arab Emirates, incidents or practices of this nature may be reported to the Dubai Police Cyber Crime Cell.
At JTS Medical Centre, we have a professional recruitment process in place, and we do not charge job seekers any fees or request payment in exchange for job offers. If you have any doubts about the authenticity of a website or job offer, please contact our Human Resources Department at +971 4 3799954 for verification.
Thank you for your attention and cooperation in this matter.
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