Medical Auditor
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Key skills for this role
About the Role
Review and audit medical claims, ensure compliance with billing guidelines, and handle resubmissions while requiring a medical graduate with coding experience.
Key Skills for This Role
Responsibilities
- Review and audit medical claims to ensure accuracy
- Resubmit rejected claims and follow up with doctors for justification if necessary
- Ensure agreed price list and provider manual from insurance companies are followed for billing
- Update billing officers on rejections and corrective actions
- Submit claims with proper codes and format to insurance companies within stipulated time
Requirements
- Experience in reviewing and auditing medical claims
- Knowledge of insurance company price lists and provider manuals
- Ability to handle resubmission of rejected claims and follow up with doctors for justification
- Familiarity with proper coding and claim submission formats
Full Job Posting
Responsibilities
- Review and Audit Medical Claims to ensure their accuracy.
- Resubmission of rejected claims.
- Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
- Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.
- Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
- Submit the claims with proper codes and format to insurance companies within the stipulated time.
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