Medical Clinical Auditor

Introduction

Do you have excellent leadership and communication skills? Then we are looking
for you! Our client is looking for a Medical Clinical Auditor. Our client is a
large private hospital in the state of Kuwait. Their dedication towards
development and growth is reflected in the ongoing expansion. Care is provided
through a competent and diverse team of health care professionals in multiple
departments, utilizing the latest technology and applying evidence-based
practices.

What we offer

Your salary is a tax free salary! You will have a direct and permanent
employment with our client, for either ‎2 or ‎3 years. Healthcare insurance or
medical treatment is part of that employment. You work in an international
team & working environment. All leave and end of service benefits as per
Kuwait Labor Law.

Description

Our client is hiring a Medical Clinical Auditor to further develop and improve
their Insurance Department. The aim of this role is to lower the overall
rejection rate of claims and reduce the waiting time for approval; by
reviewing the current process, improve and innovate the department and its
processes. It also includes training and introducing hospital employees to new
and improved processes to reach the set goals. The ideal candidate is a
seasoned healthcare professional, a people person, who is outgoing, energetic
and positive with a willingness to learn.

Major Responsibilities:
* Develop/implement strategy, policies and procedures in line with hospital vision and mission;
* Setting goals and objectives for different teams and ensuring their implementation as well as providing necessary training to team members;
* Ensures staff communicates courteously with customers by telephone, email, letter and face to face;
* Develops and maintains good knowledge of services provided by medical insurance companies including medical insurance policies, its terms and conditions;
* Assists the Finance Manager in finalizing agreements with Insurance Companies, TPAs and other parties;
* Ensures that the rules of Insurance companies/ TPAs and other parties are defined, tested and updated from time to time in the system;
* Ensures that all assets are adequately covered by insurance;
* Ensures that all the insurance policies are in force and valid;
* Ensures that premiums are paid in time, refund of premiums are claimed due to change in terms, and claims are settled in time;
* Executes appropriate collection activities in accordance with practice/standard operating guidelines;
* Receive various forms, reports, correspondence, budget documents, audit reports, policies, procedures, manuals, reference materials, or other documentation and reviews, completes, processes, forwards or retains as appropriate. Ensures that agreements and other records are accurately maintained, updated and kept under safe custody;
* Coordinates audits of external auditors and assists auditors in conducting;
* Reviews insurance records for deficiencies and reports the deficiencies using appropriate mechanics;
* Communicates with insurance companies regarding changes in policies, new laws, coding changes or other requirements that take place periodically.

Who are you

You are excellent in organizing, planning and decision making. Furthermore you
meet the following job requirements:
Skills & Competencies:
* Excellent leadership and communication skills;
* Mature, self-driven and able to relate positively with various players in the healthcare industry;
* Excellent organizing, planning and decision making skills;
Education & Qualifications:
* Medical educational background - MBBS;
* Medical knowledge and experience in healthcare system in Kuwait is mandatory;
* Knowledge of insurance companies and policies is highly preferred;
* Available locally in Kuwait;