CLINICAL AUDITOR - BUSINESS OFFICE

General Requirements

• Degree in Medicine, Hospital Administration or any related field
• Minimum 3 years experience in hospital billing, coding or healthcare auditing
• Profound knowledge of healthcare regulations for insurance billing
• Excellent attention to detail and analytical skills
• Ability to work independently and collaborate with billing and clinical staff

Job Specification

• Audit inpatient bills to ensure accuracy and compliance with hospital policies and insurance requirements
• Monitor the discharge billing process and ensure timely completion of bills within the stipulated time frame
• Review and verify insurance documents, GOPs, coding accuracy, and medical documentation related to patient care
• Escalate and investigate billing discrepancies, charge errors, and potential fraud
• Relay critical billing-related information during shift handovers and in coordination meetings
• Monitor high-balance accounts and recommend timely interventions
• Resolves guest problems quickly, efficiently, and courteously
• Prepare weekly/monthly reports on billing errors and delayed discharges
• Recommend process improvements to reduce repetitive billing issues or documentation gaps
• Ensure policies and procedures for the Business Office are up to date and adhered to
• Review Guest feedback on a daily basis and manage Guest complaints related to billing