medical auditor

NMC Health plc

<div>3.1 Review and Audit Medical Claims to ensure their accuracy.
3.2 Resubmission of rejected claims
3.4 Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers
3.5 Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
3.6 Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
3.7 Submit the claims with proper codes and format to insurance companies within the stipulated time.</div>
 <div><ul><li>Review and Audit Medical Claims to ensure their accuracy.
 </li><li>Resubmission of rejected claims
 </li><li>Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers
 </li><li>Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future
 </li><li>Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
 </li><li>Submit the claims with proper codes and format to insurance companies within the stipulated time.</li></ul></div>
 <div><ul><li>Medical/Nursing graduate from a recognized university.
</li><li>Experience in Insurance Claims Resubmission
</li><li>Experience in Medical Coding is preferable.
</li><li>Excellent command of oral and written English.</li></ul></div>

Medical Auditor

sequel technologies

Job Title: Medical Billing Auditor Location: Bahria Town Phase 7, Rawalpindi Employment Type: Full-Time, On-site Position Summary:The medical billing auditor is responsible for reviewing, analyzing, and auditing medical billing, coding, and documentation to ensure accuracy, compliance, and optimal reimbursement. This role ensures that claims are submitted according to payer guidelines, coding standards, and organizational policies. The auditor also identifies errors, trends, and opportunities for process improvement within the revenue cycle.Key Responsibilities:<ul><li>Conduct regular audits of medical billing and coding records to verify compliance with CPT, ICD-10, HCPCS, and payer-specific guidelines.</li><li>Review claims before and after submission to ensure accuracy and completeness.</li><li>Identify and document billing errors, compliance issues, and patterns of concern.</li><li>Prepare detailed audit reports and present findings to management, coders, and billing teams.</li><li>Collaborate with providers, coders, and billing staff to correct identified errors and prevent future discrepancies.</li><li>Monitor regulatory changes (CMS, OIG, HIPAA, and payer rules) and ensure billing practices align with the latest compliance requirements.</li><li>Participate in developing and implementing audit plans, training programs, and corrective action plans.</li><li>Support internal and external audits and assist in resolving payer denials related to coding or billing inaccuracies.</li><li>Track audit results and report trends, risks, and recommendations for improvement.</li><li>Maintain confidentiality and compliance with all applicable healthcare regulations and policies.</li></ul>Qualifications Education:<ul><li>Bachelor&rsquo;s degree in healthcare administration, health information management, or a related field (preferred).</li><li>An associate degree or equivalent experience in medical billing/coding may be considered.</li></ul>Experience:<ul><li>3+ years of experience in medical billing, coding, or revenue cycle management.</li><li>Prior experience conducting audits or compliance reviews is strongly preferred.</li></ul>Certifications (preferred or required):<ul><li>Certified Professional Coder (CPC, CIC, or COC) &ndash; AAPC</li><li>Certified Coding Specialist (CCS) &ndash; AHIMA</li><li>Certified Professional Medical Auditor (CPMA) &ndash; AAPC (strongly preferred)</li></ul>Skills:<ul><li>In-depth knowledge of ICD-10, CPT, HCPCS, and payer billing requirements.</li><li>Strong analytical and problem-solving abilities.</li><li>Excellent attention to detail and accuracy.</li><li>Proficient in EHR and billing software (e.g., Epic, Cerner, Athenahealth, NextGen, etc.).</li><li>Strong written and verbal communication skills.</li><li>Ability to work independently and handle confidential information with integrity.</li></ul>Performance Indicators:<ul><li>Audit accuracy and completion rates</li><li>Reduction in billing errors and payer denials</li><li>Compliance with internal and external regulations</li><li>Timely reporting and resolution of audit findings</li></ul>Job Type: Full-timeWork Location: In person

Medical Billing Auditor

sanjivini hospital & research center

<ul><li>INR 20,000 - 30,000 per month (dependent on experience)</li><li>Full-time role</li><li>On-site</li></ul>About us:Sanjivini Super Speciality Hospital is a leading tertiary-care, multi-speciality hospital located in Gomti Nagar, Lucknow. Established with a commitment to delivering affordable world-class medical care, the hospital is home to a team of highly experienced super-specialist doctors, many of whom bring over three decades of clinical expertise to the table.Job Summary:We are seeking a meticulous and knowledgeable Pharmacy Auditor to oversee and evaluate pharmacy operations, compliance, inventory control, and regulatory adherence.<ul><li>Conduct routine and surprise audits of pharmacy operations, including inpatient, outpatient, and satellite pharmacies.</li><li>Audit stock levels and medication inventory to detect discrepancies, pilferage, or overstocking.</li><li>Recommend and monitor corrective actions for stock variances or process gaps.</li><li>Maintain detailed audit records and prepare comprehensive reports on findings, risks, and recommendations.</li><li>Present findings to senior management and participate in regular audit review meetings.</li></ul>Requirements:<ul><li>Bachelor&rsquo;s or Master&rsquo;s degree in Pharmacy (B.Pharm or M.Pharm); Pharm.D preferred.</li><li>Additional certification in auditing, healthcare quality, or regulatory compliance is an advantage.</li><li>Minimum 3 years of experience in a hospital pharmacy; prior audit or compliance experience preferred.</li></ul>If you are the one hit the apply button to submit your application or e-mail hr@sanjivinihospitals.comJob Type: Full-timePay: &#8377;20,000.00 - &#8377;30,000.00 per monthWork Location: In person

Pharmacy Auditor

Navi

<div>
 
 
 
 About the Team
 
 
 
 
 The Process Excellence team at Navi is focused on maintaining and elevating the quality of customer interactions. As the quality audit function, the team conducts regular audits of agent communications&mdash;across calls, chats, and other channels&mdash;to ensure accuracy, consistency, and compliance. The team also ensures compliance across different verticals and runs multiple initiatives in coordination with business team stakeholders to drive key business metrics. Insights from these audits are used to drive continuous improvement through targeted training, helping agents close knowledge or process gaps and deliver a consistently excellent customer experience.
 
 
 
 
 
 
 
 About the Role
 
 
 
 
 We are seeking an experienced doctor with medical knowledge, analytical skills for process excellence to join our dynamic team..The ideal candidate will be responsible for strategic claim auditing, insight-driven reporting, stakeholder engagement, and improvement areas. The auditor should be able to identify patterns and process gaps. will collaborate with cross-functional teams like claims, network providers, and investigations. product, analytics, automation &amp; compliance to ensure successful delivery of initiatives.
 
 
 
 
 
 
 
 What We Expect From You
 
 
 
 <ul>
 <li>
 Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.
 </li>
 <li>
 Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submitted
 </li>
 <li>
 Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors
 </li>
 <li>
 Providing detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activities
 </li>
 <li>
 Recommend actions based on findings, such as denying, reducing, or adjusting claims
 </li>
 <li>
 Communicate audit results and findings to management and external stakeholders
 </li>
 <li>
 Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations.
 </li>
 <li>
 Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submitted
 </li>
 <li>
 Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors
 </li>
 <li>
 Providing detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activities
 </li>
 <li>
 Recommend actions based on findings, such as denying, reducing, or adjusting claims
 </li>
 <li>
 Communicate audit results and findings to management and external stakeholders
 </li>
 </ul>
 
 
 
 
 
 
 Must Haves
 
 
 
 <ul>
 <li>
 Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS)
 </li>
 <li>
 Experience in handling audit
 </li>
 <li>
 Background in claims processing with clinical experience in a hospital setting
 </li>
 <li>
 Data analytics experience would be an added advantage
 </li>
 <li>
 Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.
 </li>
 <li>
 Knowledge of health insurance policies and regulations, IRDAI circulars is must
 </li>
 <li>
 Strong analytical and problem-solving skills.
 </li>
 <li>
 Excellent attention to detail and ability to spot discrepancies
 </li>
 <li>
 Ability to anticipate potential problems and take appropriate corrective action
 </li>
 <li>
 Effective communication skills for working with different stakeholders
 </li>
 <li>
 Time management skills to meet deadlines.
 </li>
 <li>
 Should have a broad understanding of Claims Practice
 </li>
 <li>
 Sharp business acumen to understand health insurance claim servicing needs
 </li>
 <li>
 Excellent communication skills, including writing reports and presentations
 </li>
 </ul>
 
 
 
 
 
 
 Inside Navi
 
 
 
 
 We are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal &amp; Home Loans to UPI, Insurance, Mutual Funds, and Gold &mdash; we&rsquo;re building tech-first solutions that work at scale, with a strong customer-first approach.
 
 
 
 
 
 Founded by Sachin Bansal &amp; Ankit Agarwal in 2018, we are one of India&rsquo;s
 
 
 fastest-growing financial services organisations. But we&rsquo;re just getting started!
 
 
 
 
 
 
 
 Our Culture
 
 
 
 
 
 
 The Navi DNA
 
 
 
 
 
 Ambition. Perseverance. Self-awareness. Ownership. Integrity.
 
 
 
 We&rsquo;re looking for people who dream big when it comes to innovation. At Navi, you&rsquo;ll be empowered with the right mechanisms to work in a dynamic team that builds and improves innovative solutions. If you&rsquo;re driven to deliver real value to customers, no matter the challenge, this is the place for you. We chase excellence by uplifting each other&mdash;and that starts with every one of us.
 
 
 
 
 
 
 
 Why You'll Thrive at Navi
 
 
 
 
 At Navi, it&rsquo;s about how you think, build, and grow. You&rsquo;ll thrive here if:
 
 <ul>
 <li>
 
 You&rsquo;re impact-driven
 
 : You take ownership, build boldly, and care about making a real difference.
 </li>
 <li>
 
 You strive for excellence
 
 : Good isn&rsquo;t good enough. You bring focus, precision, and a passion for quality.
 </li>
 <li>
 
 You embrace change
 
 : You adapt quickly, move fast, and always put the customer first.
 </li>
 </ul>
</div>

Senior Claims Manager - Medical Claim Audit

Seven Sigma Healthcare Solutions Pvt Ltd

We, Seven Sigma Healthcare is a leading Revenue Cycle Management company with Pan India Presence. We are processing and claiming health insurance claims for our client hospitals in India. We are looking for Medical Auditors to work with us in the claiming process. BSc / GNM Nurses can apply. Preference to those who are residing within 20 KM near Perinthalmanna.Job Type: Full-timePay: &#8377;12,000.00 - &#8377;20,000.00 per monthBenefits:<ul><li>Health insurance</li></ul>Work Location: In person

BSc / GNM Nurse

Adeptmed Healthcare Solutions

Location: Gurugram, Haryana Company: AdeptMed Healthcare Solutions LLP Shift: Night Shift (US Healthcare Process) Experience: 4 &ndash; 9 years Working Days: Monday to FridayAbout the Role:AdeptMed Healthcare Solutions LLP is hiring experienced Nurse Auditors / Clinical Documentation Specialists to join our growing US Healthcare team. You&rsquo;ll be responsible for reviewing clinical documentation, auditing medical records, and ensuring compliance with US healthcare standards.Key Responsibilities:<ul><li>Review and audit clinical documentation in EHR systems for accuracy and completeness.</li><li>Identify and correct discrepancies in nursing notes, care plans, and assessments.</li><li>Ensure compliance with MDS / PDPM and other regulatory requirements.</li><li>Work closely with MDS coordinators, physicians, and facility staff to resolve documentation issues.</li><li>Prepare audit reports and recommend corrective actions.</li><li>Stay updated with CMS and SNF compliance guidelines.</li></ul>Qualifications:<ul><li>B.Sc. / M.Sc. Nursing (AIIMS or equivalent preferred).</li><li>Registered Nurse (RN) &ndash; India or International License (preferred).</li><li>4&ndash;9 years of experience in hospital, clinical, or documentation roles.</li><li>Prior experience in clinical review / medical audit / DRG validation preferred.</li><li>Excellent communication, analytical, and computer skills (MS Office, EHR).</li></ul>Perks &amp; Benefits:<ul><li>Competitive salary based on experience.</li><li>5-day working week (Saturday&ndash;Sunday off).</li><li>Growth opportunities in the US Healthcare audit domain.</li><li>Supportive and collaborative work environment.</li></ul>You can share your resume at Info@adeptmed.in or share your resume at 9220511288 ( onlywhatsapp )Job Type: Full-timePay: &#8377;500,000.00 - &#8377;1,000,000.00 per yearBenefits:<ul><li>Flexible schedule</li><li>Health insurance</li><li>Leave encashment</li></ul>Work Location: In person

Nurse Auditor / Clinical Documentation Specialist (Night Shift)

IHG Hotels & Resorts

Prepares daily income report.
  Investigates discrepancies and corrects same as indicated in Night Auditor and Restaurant Auditor’s Logbook.
  Compares the Housekeeper’s Report against Night Receptionist room report. Lists the discrepancies noted and make investigation of these discrepancies and takes appropriate action.
  Perform duties indicated in the Income Auditor check list (copy attached).
  Supervises the activities of Assistant Income Auditor and Night Auditor.
  Ensure completion of monthly Income Auditor check list.
  Reports in Logbook all discrepancies for the attention of Internal Auditor and Controller.
  Supervises and controls Restaurant Checks issues Logbook.
  Complies with Hotel’s Health, Safety & Hygiene policy.
  Perform related duties and special projects as assigned.
 
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Income Auditor - InterContinental Jeddah

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