Group Auditor - OP Coding is responsible for carrying out internal audits focused on revenue cycle transactions including claims, billing, collections, and coding. This role identifies trends and errors, assesses process compliance, and ensures accurate documentation and billing practices. The position collaborates closely with internal teams to address audit findings and implement corrective actions. The position also supports external audit preparation, maintains audit documentation, and contributes to continuous improvement in RCM processes.
Responsibilities:
The post holder will:
Execute regular audits on claims, billing records, payment posting, and coding accuracy across various specialties and service lines
Identify areas of revenue leakage, recurring denial trends, and documentation gaps that affect reimbursement
Verify that billed services are correctly supported by documentation and aligned with payer-specific rules and guidelines
Develop detailed audit reports including findings, risk ratings, root causes, and recommendations for corrective actions
Assist departments in implementing changes based on audit feedback and monitor improvements in subsequent audit cycles
Participate in the development and updating of internal audit tools, workflows, and compliance protocols
Coordinate with billing, coding, and insurance teams to clarify audit queries and gather supporting documentation
Prepare for external audits by organizing necessary evidence, addressing potential audit risks, and responding to information requests
Track audit metrics such as error rates, audit compliance scores, and improvements post-corrective actions
Contribute to training and awareness sessions on common audit findings and prevention strategies
Stay informed of changes in UAE healthcare regulations, payer policies, and compliance standards to keep audit procedures current
Qualifications:
Education and Certification: Bachelor’s degree in Life science or Healthcare Administration, or a related field. Hold Valid Coding certification ( AAPC or AHIMA)
Knowledge and Skills:
Knowledge of revenue cycle processes, audit principles, and healthcare billing workflows
Understanding of UAE insurance regulations and payer compliance standards
Strong analytical and critical thinking skills with a focus on identifying patterns and discrepancies
Proficiency in billing and claims systems with the ability to extract and review audit data
Excellent written and verbal communication skills for preparing detailed audit documentation
Ability to work independently and collaboratively in a fast-paced, accuracy-driven environment
Experience:
Revenue leakage identification
Claims auditing
Compliance reporting
Denial trend analysis
Clinical documentation review
Payer rule validation
At least 3+ years of experience in revenue cycle operations or internal audit, preferably in a healthcare organization within the UAE