Team Leader - Hospital Auditor

Job Overview-

As a Hospital Auditor at Mediassist Insurance TPA, your primary role will be to conduct E-audits (Virtual Audits) of hospital ensuring that the Infrastructure of the hospital comply with internal policies, regulatory requirements, and contractual obligations. The aim is to validate existence of the hospital, manpower and statuary documents records in order to ensure that the hospital has legimate infrastructure as per the regulatory norms aligned with IRDA.

The position involves reviewing hospital documents, infrastructure through technical means and on-boarding providers with contracting.

Key Responsibilities:-

Hospital Infrastructure Audit-Review and analyze hospital infrastcruture through Virtual audit ensuring that the Infrastructure of the hospital comply with internal policies, regulatory requirements, and contractual obligations.

Evaluate Provider Documents: Verify and cross check provider documents as per the check list provided by the Organisation.

Evaluate Provider Manpower-Verify and validate the manpower in compilance with regulatory norms.

Ensure Billing Compliance: Ensure that Hospital Billing infrastructure meets the internal company guidelines,and medical billing standards.

Identify Risk Areas: Identify potential risks and patterns of fraud or abuse in hospital billing and red flag such hospitals for further empanelment process.

Training & Development: Stay up to date on current healthcare regulations,provider compilance as per the norms provided by IRDA.

Required Skills & Qualifications:

• Education: Bachelor's degree in Healthcare Administration, Medical Billing and Coding, Finance, Accounting, or a related field. Relevant certifications , BAMS,BHMS &BDS.
• Experience: At least 2-3 years of experience in hospital contracting, hospital management.
• Knowledge: In-depth understanding of hospital Infrastructure (Different Dept Including OT ICU etc.)
• Analytical Skills: Strong attention to detail and ability to analyze complex related softwares.
• Communication Skills: Excellent written and verbal communication skills, with the ability to interact professionally with healthcare providers and internal teams.
• Software Proficiency: Familiarity with claims processing software, medical billing software, and MS Office applications (Excel, Word, PowerPoint) and also virtual audit related softwares.

Intertested candidates can share their profiles to neethu.k@mediassist.in