Medical Auditor

Roles and responsibilities

Monitor, review and update patient’s record files both in-patient and out-patient to ensure the completeness and proper documentation are observed with the accordance to both local and international standards.

Key Responsibilities / Accountabilities

• Review medical records from departments such as Emergency Department (ER), In-patient and Out-patient departments based on review requirements using established international and local standards.
• Organize and prioritize work to ensure that all review documents are completed in accordance with the pre-set timelines.
• Work in collaboration with Medical Administration and Quality Department to ensure efficient records reviews are complete.
• Review prior discharge of patient files for the completeness and by assuring the accuracy of a Medical Records.
• Follow-up of incomplete documents by calling the concern physicians (consultants, specialists and residents).
• Coordinate in-service meetings to educate medical staffs on the proper documentation procedures and repot any incorrect or missing documents to the concerned physician and/or HOD for the completion.
• Actively participates in Quality meetings/ reviews as required to certify adherence to established concrete guidelines.
• Prepare and present monthly report in Quality Meetings and Surveys.
• Prepare a regular meeting to the physicians known to have deficient medical files for education.
• Orienting newly hired physicians for all related issues in the department i.e. VIDA System, Approval and Claims.
• Assure the full representation of clinical pathway in all file compartments.
• Comply with the standards laid down by the Joint Commission International Accreditation (JCIA) / Central Board for Accreditation of Healthcare Institutions (CBAHI).
• Follow and apply medical records department policy and procedure and insures that other staffs were following it.
• Report to Medical Coordinator for any violation of Medical Records Documentation (MRD) and Policies and procedures (P&P).
• Adhere the safety and security measures and apply the infection control measures.
• Participate in the hospital education activity program.
• Participate in, and lead person-centered care initiatives undertaken by HMG.
• Enrich patient experience with compassion, respect and dignity.
• Perform all other tasks/duties assigned within the realm of his/her knowledge, skills and abilities.

Desired candidate profile

Education/ Professional Qualification

Bachelor’s Degree
Professional - Nursing; preferably Medicine and Surgery

Experience

Preferably four (4) years’ experience in a medical records environment.
Regulatory Knowledge:
Strong understanding of healthcare compliance regulations, including HIPAA, CMS billing policies, Medicaid, and Medicare reimbursement protocols.
Ability to keep up-to-date with changes in healthcare laws, regulations, and guidelines to ensure compliance in audits.
Analytical & Investigative Skills:
Excellent attention to detail and analytical skills for identifying discrepancies or patterns of error in medical records, claims, and coding.
Proficient in analyzing data, identifying trends, and developing actionable reports for process improvements or corrective actions.
Strong problem-solving skills to resolve issues identified during audits and ensure resolution in a timely and effective manner.
Communication Skills:
Strong verbal and written communication skills to clearly explain audit findings to healthcare providers, coding teams, and management.
Ability to provide training and support to medical staff on coding, billing, and documentation best practices.
Skilled in preparing clear, concise, and well-organized audit reports, recommendations, and action plans.
Technical Skills:
Proficient in using electronic health record (EHR) systems and medical billing software (e.g., Epic, Cerner, Meditech).
Proficiency in Microsoft Excel and other data analysis tools for compiling, reviewing, and reporting audit findings.
Familiarity with coding and billing software used in healthcare settings.