Group Auditor - IP Coding

Overview

Responsibilities

• 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