Group Auditor - IP Coding
Skills
About This Role
Overview
- Group Auditor - IP Coding performs detailed audits of inpatient cases, including documentation, coding, charge capture, medical necessity, LOS justification, and DRG placement.
- The role evaluates adherence to UAE payer rules, DRG guidelines, and internal standards across multiple hospitals.
- The Auditor collaborates closely with coding, CDI, revenue integrity, case management, and clinical teams to communicate findings, drive corrective actions, and monitor improvements.
- The position also supports external audit preparedness, internal risk mitigation, and enterprise-wide compliance initiatives.
- The post holder will:
- Conduct comprehensive audits of inpatient claims, coding accuracy, DRG assignment, LOS justification, and documentation completeness.
- Verify that clinical documentation appropriately supports coded diagnoses, procedures, and DRG weight.
- Audit high-value claims, clinical high-risk specialties, and cases flagged for denials or variances.
- Identify inpatient revenue leakage including under-coding, missed comorbidities, incorrect DRG shifts, undocumented services, and lost charges.
- Detect patterns of coding/documentation gaps leading to reduced reimbursement.
- Analyze trends in inpatient denials, takebacks, and medical necessity disputes.
- Develop detailed corporate audit reports including findings, risk scoring, variance analysis, and recommendations.
- Present audit insights to hospital leadership and corporate RCM teams.
- Collaborate with facility teams to close findings, implement corrective actions, and track post-audit improvement.
- Provide feedback to CDI, coding, and case management for improving clinical documentation quality.
- Contribute to training and awareness sessions on common audit findings and prevention strategies
- Stay informed of changes in UAE healthcare regulations, payer policies, and compliance standards to keep audit procedures current
Education
- and Certification: Bachelor’s degree in nursing, Life Sciences, Health Information Management, or Healthcare Administration.
- Holding valid Coding certification ( AAPC or AHIMA)
- Knowledge and Skills:
- Deep understanding of UAE DRG system, inpatient coding, billing workflows, and medical necessity guidelines.
- Strong analytical skills to interpret complex clinical cases and DRG structures.
- Proficiency in EMR, HIS, coding systems, and audit tools.
- Strong written and verbal communication for preparing detailed corporate‐level audit reports.
- Ability to work independently and collaborate with multi-disciplinary teams across several facilities.
Experience
- DRG validation and severity level evaluation
- Medical necessity and LOS audits
- High-cost drug, device, and procedure justification
- Denial root-cause analysis & compliance reporting
- Revenue leakage detection in inpatient settings
- Clinical documentation review & CDI alignment
- Minimum 4–6 years in inpatient coding/auditing or RCM operations within a UAE healthcare organization
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