Review medical records and associated documentation to ensure they are complete, accurate, and compliant with relevant regulations.
The Medical Auditor is responsible for performing detailed audits of medical records and other data to identify errors and inaccuracies, and to assess the accuracy of claims submitted for payment
The auditor will also provide guidance and assistance to medical providers on how to improve their documentation and coding practices.
The ultimate goal is to ensure that all medical services are properly documented, coded, and billed in order to maximize reimbursement and minimize fraud and abuse
Analyze medical data for cost efficiency and appropriateness of care
Properly audit all type of claims from the medical and insurance perspective
Assure meeting the daily assigned target in terms of quantity & quality
Report back any type of claims observation or issues that may affect the process.
Participate in developing the billing system by providing new ideas or proposal in order to enhance the process
Contribute in developing, updating and implementing the guidelines for evaluation and processing of medical claims, as well as policies and procedures and work instructions related to medical claims review and processing
Gather relevant information to clearly describe and properly escalate issues to insurance manager
Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner
Conduct training to improve the technical, insurance and medical skills and knowledge for team members as assigned by insurance manager
Provide all the needed support as advised by insurance manager based on the business need
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