Medical Auditor

January 27, 2025

Job Description

  • 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.

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.

Qualifications

  1. Medical/Nursing graduate from a recognized university. 
  2. Experience in Insurance Claims Resubmission
  3. Experience in Medical Coding is preferable.
  4. Excellent command of oral and written English.