Primary Responsibilities:

- Ensure that the medical ethics are respected at all times while performing the medical evaluation of the claims.

- Responsible for retrospective and concurrent reviews on coding staff.

- Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed.

- Review provider's specifications and highlight inconsistencies or lack of information. Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner.

- Conduct training to improve the technical, insurance and medical skills and knowledge for team members as assigned by the QA lead.

- Participate and contribute during biweekly calibration on error grading standards to help build a robust Quality Program along with QA lead.

- Provide all required support as advised by the supervisor/Manager based on the business need.

- Responsible of successful Ramp up plan of new coders





- Ensure the audit tracker is updated and the data provided is accurate.

- Suggestions to create audit tools and strategies to improve the audit process

Job Requirements:

- Bachelors Degree in the medical field or science background

- Coding certification from AAPC or AHIMA is must

- Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, HCPCS codes, modifiers, MUEs, CCI edits and/ or MS-DRGs (Diagnosis related groups)

- Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology)

- At least 2-3 years medical claims auditing experience

- Having UAE experience is an added advantage

- Good knowledge of insurance protocols

- Should have good IT skills

Presentation and/or positive communication skills to deliver feedback on audit findings.

📌 Quality Auditor (Chennai)
🏢 ACCUMED
📍 Chennai