Analyst - Clinical Billing Compliance

Responsibilities:

• Reviews medical records for documentation standards required by Minstry of Public Health
• Analyses coding and charging by outpatient departments following the NHIC guidelines.
• Provides analysis to support Client's service/procedure compliance programs.
• Reviews medical records for documentation standards required by Minstry of Public Health to quantify correct compliant billing.
• Analyses coding and charging by Outpatient departments following the NHIC guidelines for QOCS specific to high riyal departments, i.e.; Emergency Room, Specialty Clinics, procedures performed within the clinics.
• Provides learning outcomes and recommends actions to clinical areas based on the analysis of findings from audits for documentation and for billing and charging services rendered.

Education

Bachelors Degree in commerce, health information or relevant discipline

Experience

3+ years charge description master auditing and Compliance charge audit for lost charge as well as Insurance claims auditing in a hospital. Documentation audits for medical necessity and physician documentation for correct assignment of DRG/ICD-10 CM coding.

Certification and Licensure:

Prefer Coding certification for hospital and or physician from AAPC or AHIMA 

Professional Membership

HCCA or other Compliance Organization for Healthcare

Job Specific Skills and Abilities

• Timely completion of tasks, charge capture audits based on NHIC guidelines, and commercial insurance, Compliance audits DRG, ICD-10 CM Coding, Compliance Policy Audits
• Proficiency with Microsoft Office suite
• Fluency in written and spoken English