Auditor Specialist – Financial Performance Optimizer

1 week ago


Rawalpindi Cantonment, Pakistan Meds Nexus Private Limited Full time

About the Role

Meds Nexus Private Limited is seeking a highly skilled Auditor Specialist to join its Revenue Cycle Management (RCM) team. As an RCM expert, you will play a vital role in overseeing the auditing processes within the medical billing and credentialing functions.

Key Responsibilities:

  1. Audit Planning and Execution:
  • Develop and implement comprehensive audit plans for medical billing and credentialing processes.
  • Conduct regular audits on charge entries, payment postings, and claim submissions to ensure compliance with industry standards and company policies.
  • Review coding practices and billing procedures to ensure accuracy in documentation and claims.
Compliance and Regulatory Adherence:
  • Ensure all billing and credentialing activities comply with relevant regulations (HIPAA, CMS guidelines, etc.).
  • Monitor for adherence to payer-specific billing rules and government regulations.
  • Stay updated on changes in healthcare laws and ensure the team is compliant.
Consulting and Mentorship:
  • Serve as a role model and mentor to less experienced personnel on professional standards of performance.
  • Provide consulting services and lead independent audits and assessments to improve operations and manage risks related to complex technology and processes.
  • Mentor, train, and enhance the knowledge of Senior/Staff Auditors and other business area teams in auditing and RCM processes.
Performance Analysis and Reporting:
  • Analyze audit findings to identify trends, issues, and areas for improvement in the RCM process.
  • Provide detailed reports on audit outcomes to the HOD Operations, outlining key performance indicators (KPIs), compliance issues, and recommendations for improvement.
  • Ensure the preparation and delivery of KPI & MTD (Month to Date) reports to track performance, which will directly influence bonuses and incentives for team members.
  • Work closely with teams to resolve discrepancies and implement solutions to enhance revenue cycle efficiency.
Follow-up and Remediation:
  • Follow up on past audit findings to ensure timely and adequate remediation.
  • Implement corrective action plans based on audit outcomes to enhance overall compliance and financial performance.
Risk Management and Quality Control:
  • Identify and mitigate risks associated with the revenue cycle by ensuring strict compliance and best practices in billing and credentialing.
  • Conduct regular risk assessments and recommend strategies to minimize financial losses or compliance violations.
Continuous Improvement:
  • Recommend process improvements to optimize the revenue cycle workflow and enhance operational efficiency.
  • Lead efforts to implement automation and advanced technology solutions for RCM auditing.
  • Track performance metrics and recommend actions for improved revenue capture and reduced denials.

Qualifications and Skills:

The ideal candidate will have a Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field, with certification in Medical Billing/Coding, RCM, or relevant certifications preferred. At least 5 years of experience in medical billing, credentialing, and RCM auditing, with leadership experience preferred.

Benefits:

Meds Nexus Private Limited offers a competitive salary package, including paid leaves, HR bonus, loan policy, advance salary, yearly loyalty rewards, performance-based bonuses, leave encashment, inflation bonus, promotion, increments, medical benefits, employee contributory saving plan, Saturday and Sunday off, complimentary food and tea/green tea.



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