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.
- 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.