Group Auditor - OP Coding
Skills
About This Role
Overview
- Group Auditor - OP Coding is responsible for carrying out internal audits focused on revenue cycle transactions including claims, billing, collections, and coding.
- This role identifies trends and errors, assesses process compliance, and ensures accurate documentation and billing practices.
- The position collaborates closely with internal teams to address audit findings and implement corrective actions.
- The position also supports external audit preparation, maintains audit documentation, and contributes to continuous improvement in RCM processes.
- The post holder will:
- Execute regular audits on claims, billing records, payment posting, and coding accuracy across various specialties and service lines
- Identify areas of revenue leakage, recurring denial trends, and documentation gaps that affect reimbursement
- Verify that billed services are correctly supported by documentation and aligned with payer-specific rules and guidelines
- Develop detailed audit reports including findings, risk ratings, root causes, and recommendations for corrective actions
- Assist departments in implementing changes based on audit feedback and monitor improvements in subsequent audit cycles
- Participate in the development and updating of internal audit tools, workflows, and compliance protocols
- Coordinate with billing, coding, and insurance teams to clarify audit queries and gather supporting documentation
- Prepare for external audits by organizing necessary evidence, addressing potential audit risks, and responding to information requests
- Track audit metrics such as error rates, audit compliance scores, and improvements post-corrective actions
- 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 Life science or Healthcare Administration, or a related field.
- Hold Valid Coding certification ( AAPC or AHIMA)
- Knowledge and Skills:
- Knowledge of revenue cycle processes, audit principles, and healthcare billing workflows
- Understanding of UAE insurance regulations and payer compliance standards
- Strong analytical and critical thinking skills with a focus on identifying patterns and discrepancies
- Proficiency in billing and claims systems with the ability to extract and review audit data
- Excellent written and verbal communication skills for preparing detailed audit documentation
- Ability to work independently and collaboratively in a fast-paced, accuracy-driven environment
Experience
- Revenue leakage identification
- Claims auditing
- Compliance reporting
- Denial trend analysis
- Clinical documentation review
- Payer rule validation
- At least 3+ years of experience in revenue cycle operations or internal audit, preferably in a healthcare organization within the UAE
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