Group Auditor - OP Coding

Overview

Responsibilities

• 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