Medical Auditor / Research Officer

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We are recruiting to fill the position below:

Job Title: Medical Auditor / Research Officer

  • Location: Abuja
    Employment Type: Full TimeJob Description
  • Reviewing insurance claims for accuracy, including reviewing medical records for documentation of services rendered and items supplied
  • Conducting onsite audits of hospitals, clinics, nursing homes, home health agencies, or other facilities to ensure that they are adhering to safety standards and ethical guidelines
  • Assisting patients with filing appeals or grievances with their insurance companies regarding coverage or payment issues
  • Making recommendations to improve patient care based on findings of the audit
  • Reviewing and analysing data to identify possible areas of concern or risk to patients
  • Conducting internal audits to ensure compliance with federal regulations such as Medicare guidelines
  • Reviewing clinical documentation to determine whether or not it meets established standards of care
  • Conducting audits of pharmacies to ensure that medications are dispensed properly and accurately
  • Conducting routine audits of insurance claims to ensure that they have been processed correctly
  • Review medical records to ensure that documentation meets all requirements for billing and coding
  • Identify errors in documentation and work with providers to correct them Educate providers on proper documentation techniques Stay up-to-date on current coding guidelines and regulations
  • Ensure that claims are submitted in a timely manner and meet all deadlines
  • Verify that claims have been processed correctly and appeal any denied claims
  • Review provider contracts to ensure that billing and coding comply with the terms of the agreement
  • Prepare reports on audit findings and present them to management
  • Develop and implement policies and procedures related to billing and coding
  • Train new staff members on billing and coding procedures
  • Participates in all claims audit with HMO and cooperate organization to ensure full recovery of all forms
  • Prepare medical reports for all HMO patient management cases for either OPD or inpatient
  • Respond to queries and enquiries from HMO and cooperate organization on patient management
  • Will prepare supporting documents and reports for disputes and queries on patient management from HMO and cooperate organizations
  • Participate in preparing and reviewing SOP of the Department.
  • Serve as a resource to other departments on billing and coding issues
  • Perform other duties as assigned
  • Research and come up with contents (written/videos) for publications on all social media handles, journals, blogs, website and other Deda channels
  • Serve as the main medical research, manager for the hospital on a monthly basis, giving feedback to management through report on new development and best practices in patients management and hospital administration
  • Perform any other adhoc duties.

 

Requirements

  • MBBS, Registration with relevant bodies.
  • 1 – 5 years relevant work experience.
  • Attention to details: Find enlarged lymph nodes or splenomegaly on examination
  • Effective communication: Explain a disease or procedure to patients in plain, understandable terms.
  • Problem solving Skill: Recognize when a patient needs to be transferred to the ICU.
  • Ability to work in a team: Know when to call in a consultant and when to do the work themselves.
  • Ability to handle pressure
  • Display patience
  • Strong understanding of Generally Accepted Auditing Standards (GAAS)
  • Proficient in Microsoft Office, with advanced Excel skills
  • Excellent analytical, research, and problem-solving skill.

Application Closing Date
5th October, 2023.

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