Group Auditor - IP Coding

Role Overview

Group Auditor - IP Coding at NMC Healthcare. The position performs detailed audits of inpatient cases across multiple hospitals, evaluating adherence to UAE payer rules, DRG guidelines, and internal standards.

Role Purpose

Conduct comprehensive audits of inpatient coding, documentation, charge capture, and medical necessity to identify revenue leakage, ensure compliance with UAE healthcare regulations, and drive corrective actions across the enterprise.

Key Responsibilities

Audit Operations

• Conduct comprehensive audits of inpatient claims, coding accuracy, DRG assignment, LOS justification, and documentation completeness.
• Verify that clinical documentation appropriately supports coded diagnoses, procedures, and DRG weight.
• Audit high-value claims, clinical high-risk specialties, and cases flagged for denials or variances.
• Identify inpatient revenue leakage including under-coding, missed comorbidities, incorrect DRG shifts, undocumented services, and lost charges.
• Detect patterns of coding and documentation gaps leading to reduced reimbursement.

Analysis and Reporting

• Analyze trends in inpatient denials, takebacks, and medical necessity disputes.
• Develop detailed corporate audit reports including findings, risk scoring, variance analysis, and recommendations.
• Present audit insights to hospital leadership and corporate RCM teams.

Stakeholder Collaboration

• Collaborate with facility teams to close findings, implement corrective actions, and track post-audit improvement.
• Provide feedback to CDI, coding, and case management for improving clinical documentation quality.
• Contribute to training and awareness sessions on common audit findings and prevention strategies.

Compliance and Governance

• Stay informed of changes in UAE healthcare regulations, payer policies, and compliance standards to keep audit procedures current.
• Support external audit preparedness, internal risk mitigation, and enterprise-wide compliance initiatives.

Qualifications & Experience

• Bachelor's degree in nursing, Life Sciences, Health Information Management, or Healthcare Administration.
• Valid Coding certification (AAPC or AHIMA).
• Minimum 4–6 years in inpatient coding/auditing or RCM operations within a UAE healthcare organization.
• Experience with DRG validation and severity level evaluation.
• Experience with medical necessity and LOS audits.
• Experience with high-cost drug, device, and procedure justification.
• Experience with denial root-cause analysis and compliance reporting.
• Experience with revenue leakage detection in inpatient settings.
• Experience with clinical documentation review and CDI alignment.

Skills & Competencies

• Deep understanding of UAE DRG system, inpatient coding, billing workflows, and medical necessity guidelines.
• Strong analytical skills to interpret complex clinical cases and DRG structures.
• Proficiency in EMR, HIS, coding systems, and audit tools.
• Strong written and verbal communication for preparing detailed corporate-level audit reports.
• Ability to work independently and collaborate with multi-disciplinary teams across several facilities.