Medical Auditor

Job Description

DUTIES AND RESPONSIBILITIES :

• Review and Audit Medical Claims to ensure their accuracy.
• Resubmission of rejected claims 
• Ensure that the agreed price list and provider manual from insurance companies are    followed for billing the service to the respective payers.
• Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future 
• Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission. 
• Submit the claims with proper codes and format to insurance companies within the stipulated time. 
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

Responsibilities

DUTIES AND RESPONSIBILITIES :

• Review and Audit Medical Claims to ensure their accuracy.
• Resubmission of rejected claims 
• Ensure that the agreed price list and provider manual from insurance companies are    followed for billing the service to the respective payers.
• Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future 
• Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission. 
• Submit the claims with proper codes and format to insurance companies within the stipulated time.
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

Qualifications

QUALIFICATION, LICENSURE, EDUCATION, EXPERIENCE, SPECIAL SKILLS :

• Medical/paramedical (Nursing, pharmacy, etc.) graduate from a recognized university. 
• Experience in Insurance Claims management/adjudication (minimum 2 years) 
• Experience in Medical Coding is preferable. 
• Excellent command of oral and written English.