Analyst - Clinical Billing Compliance

KEY ROLE ACCOUNTABILITIES:

• Reviews medical records for documentation standards required by Supreme council of Health.

• Analyses coding and charging by outpatient departments following the NHIC guidelines.

• Provides analysis to support Sidra's service/procedure compliance programs.

• Reviews medical records for documentation standards required by Supreme Council of 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.

• Performs other duties as assigned.

• Adheres to Sidra's standards as they appear in the Code of Conduct and Conflict of Interest policies

• Adheres to and promotes Sidra's Values

QUALIFICATIONS, EXPERIENCE AND SKILLS: ESSENTIAL PREFERRED
Education Bachelor's Degree in commerce, health information or relevant discipline Master's 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 coding.
Certification and Licensure Coding certification for hospital and or physician
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 Coding, Compliance Policy Audits

• Proficiency with Microsoft Office suite

• Fluency in written and spoken English