Hospital Auditor Mumbai

3 weeks ago


Mumbai, India MediEnsure Pvt Ltd Full time

**Greetings From MediEnsure Pvt Ltd**

**Job Title: Hospital Auditor**

**Primary Role**:
As a hospital auditor, the primary role is to evaluate medical claims made by hospitals to ensure that they are medically necessary and accurately billed based on the policies and protocols of the health insurer. They also play a key role in identifying and preventing fraudulent claims by cross-referencing multiple claims and reviewing medical records in detail.

**Responsibilities**:
The primary responsibilities of a hospital auditor are:
1. Conduct audits of medical claims submitted by hospitals to ensure accuracy and appropriateness.

2. Verify the medical necessity of procedures and treatments performed on patients.

3. Identify and report fraudulent billing practices.

4. Evaluate compliance with industry regulations, such as HIPAA and Medicare/Medicaid standards.

5. Analyze medical records to determine if the care provided meets industry standards and best practices.

6. Prepare reports to present audit results to hospital management and health insurer leadership.

7. Communicate with hospital staff and physicians to ensure that they are aware of the audit process and any changes to policies or procedures.

8. Provide support and guidance to hospital staff to help them understand industry regulations and billing practices.

9. Monitor and evaluate trends in claims data to inform policy changes and improve the overall efficiency and effectiveness of the health insurer's operations.

Qualifications:
The qualifications required for a hospital auditor working for a health insurer are:
1. Bachelor's degree in health care management, finance or related field.

2. Knowledge of medical billing codes and insurance industry standards.

3. Ability to read and interpret medical records and claims documents.

4. Experience conducting audits and reviewing financial statements.

5. Excellent analytical skills and attention to detail.

6. Excellent communication skills, both written and verbal.

7. Ability to work independently and within a team environment.

8. Understanding of healthcare industry regulations and quality improvement standards.

9. Proficiency in using computer and data analysis software.

**Job Types**: Full-time, Regular / Permanent

**Salary**: ₹300,000.00 - ₹400,000.00 per year

Schedule:

- Monday to Friday
- Weekend availability

**Speak with the employer**
+91 8630533811


  • Auditor-8

    2 weeks ago


    mumbai, India 0784 Deutsche Bank Aktiengesellschaft, Filiale Mumbai Full time

    Description The Auditor will be initially working with the various teams supporting the coverage of Indian and other APAC legal entities and processes. After the initial training and development phase, the Audit Analyst/Auditor will eventually join one of the global audit teams on a permanent basis. Timing of the permanent assignment will vary...

  • Auditor-8

    2 weeks ago


    Mumbai, India 0784 Deutsche Bank Aktiengesellschaft, Filiale Mumbai Full time

    Description The Auditor will be initially working with the various teams supporting the coverage of Indian and other APAC legal entities and processes. After the initial training and development phase, the Audit Analyst/Auditor will eventually join one of the global audit teams on a permanent basis. Timing of the permanent assignment will vary...

  • IT Auditor

    4 weeks ago


    Mumbai, India Skillventory Full time

    **IT Auditor - Investment Bank - Mumbai**: - From 2 to 5 year(s) of experience - ₹ Not Disclosed by Recruiter - Mumbaior **Roles and Responsibilities** We are hiring for IT Auditor - Shadow Light IT Reviewer team at leading investment bank based in Mumbai- Extended knowledge of IT Security Risk Management concepts and with good understanding of industry...

  • Auditor

    7 days ago


    Mumbai, India Deutsche Bank Full time

    **Job Title**:Auditor - Associate/Analyst **Location**:Mumbai The **Audit Analyst/Auditor **will be initially working with the various teams supporting the coverage of Indian and other APAC legal entities and processes. After the initial training and development phase, the Audit Analyst/Auditor will eventually join one of the global audit teams on a...


  • Navi Mumbai, Maharashtra, India Global Hospital And Research Centre Full time

    Job Requirements Job Title: Digital Marketing Executive at Global Hospital & Research Centre - Navi Mumbai, MaharashtraCompany Name: Global Hospital & Research CentreLocation: Navi Mumbai, MaharashtraSalary: ₹ Lacs P.A.Employment Type: Full Time, PermanentJob Description:Are you passionate about digital marketing and ready to make your mark in a dynamic...

  • Auditor

    1 week ago


    Mumbai, India Nine Colours Pvt. Ltd. Full time

    An auditor is a professional who examines and evaluates financial records, systems, and processes to ensure accuracy, compliance with laws and regulations, and the effective functioning of an organization's financial management. The job description of an auditor may vary depending on the industry, organization, and level of experience, but here are the...


  • Navi Mumbai, India Global Hospital And Research Centre Full time

    Job Requirements Job Title: Digital Marketing Executive at Global Hospital & Research Centre - Navi Mumbai, MaharashtraCompany Name: Global Hospital & Research CentreLocation: Navi Mumbai, MaharashtraSalary: ₹1.25-3.25 Lacs P.A.Employment Type: Full Time, PermanentJob Description:Are you passionate about digital marketing and ready to make your mark in...


  • Mumbai, Maharashtra, India Thunga Hospital Full time

    Job Requirements Job Title: Digital Marketing ConsultantCompany Name: THUNGA HOSPITAL LLPLocation: Mumbai, MaharashtraSalary: INR 35, ,000 per monthEmployment Type: Full-timeJob Description:Are you passionate about the digital world and looking to make a significant impact in the healthcare industry? Look no further THUNGA HOSPITAL LLP is seeking a highly...

  • Auditor

    4 weeks ago


    Mumbai, India Immense Consulting Services Pvt Ltd Full time

    **Position: Auditor** **Division: - Empire Food Division** **Job Location** - Mumbai **Qualification** Minimum B. com, Higher degree like ICWAI/Inter CA etc **Experience** 4 to 5 years Experience in Audit firms / companies as Internal Auditor. Further few years' **experience in Hotel Industry and food Related outlets as Auditor will be...

  • Hse Auditor

    5 days ago


    Mumbai, India PSS Full time

    We are looking for experienced HSE auditors with ISO 45001 Lead Auditor certification and at least 10 years of experience in the HSE field in Mumbai. We are looking for passionate professionals who take pride in helping organizations envision and create a safer working environment for their employees. As an HSE auditor, you will be assessing organization...

  • Internal Auditor

    4 weeks ago


    Mumbai, India JHS and Associates LLP Full time

    Requirements and skills 1) Proven working experience as Internal Auditor or Senior Auditor 2) Advanced computer skills on MS Office, accounting software and databases 3) Ability to manipulate large amounts of data and to compile detailed reports 4) Proven knowledge of auditing standards and procedures, laws, rules and regulations 5) High attention to...

  • Gold Auditors

    5 days ago


    Mumbai, India Muthoot Mercantile Full time

    **Gold Auditors**: **highlights**: - Designation : Gold Auditors - Location : Mumbai, Odisha - Salary : Best in Industry - Closing Date : 30 June 2023 - Posted On : 29 May 2023 **Description**: 3 to 6 years of experience in gold loan NBFCs. Multiple locations in Mumbai & Odisha **Responsibilities**: Conduct audits and examinations of gold-related...

  • IT Auditor

    4 weeks ago


    Mumbai, India Aarvi Encon Limited Full time

    **Role**: IT Auditor **Location**:Pune || HYD || Indore || **Experience**: 7-10 Years (Relevant Experience) **Working Time Zone**: (US CST Time Zone - 6:30 PM to 3:30 AM ) **Key Scanners**: Internal Quality Audit, ISO 27000 - IT Security/SOX/SOC, CISA **Description**: 1. CISA certified - preferred big 4 or any 3rd party accountant firm experience 2....

  • Internal Auditor

    4 weeks ago


    Mumbai, India Mangalam Placement Full time

    **Company**: SBFC Finance Pvt. Ltd. **Location** Mumbai **Experience** 3-4 Years **Key Skills** Internal Audit, internal auditor, Skills Matrix, Audit Documentation, Risk Control, Analytical Skills, Risk monitoring **Position: Internal Auditor** **Qualification: CA** **Experience: 1 to 4 years** **Location: Mumbai** **Job description** - Conducting...

  • Internal Auditor

    5 days ago


    Navi Mumbai, India Successr hr tech pvt ltd Full time

    Job description Key Deliverables (Essential functions & Responsibilities of the Job): Independently conduct Store and Corporate office audit projects. Develop a clear understanding of the processes under audit. Prepare the Audit programs for the audits to be executed with clear identification of Risk, control and detailed audit steps. Evaluate the...

  • Compliance Auditor

    1 week ago


    Mumbai, India Fossgen Technologies Full time

    **Position**: Auditor Compliance **Work Location**: Mumbai **Experience**: 6+ years **Salary/CTC** - As per industry standard **Notice Period**: Immediate/1-month **Qualifications**: BE / BSc IT/ BSc Computer Science / BTech / ME / MTech facing internal & external ISO 20000 / ISO 27001 / ISO 22301 / ISO 9001 audits, measuring & monitoring process...

  • Junior Hospital Admin

    4 weeks ago


    Navi Mumbai, India NEW MILLENNIUM MULTISPECIALITY HOSPITAL Full time

    fresher with hospital administration degree **Job Type**: Fresher **Benefits**: - Leave encashment - Paid time off Schedule: - Evening shift - Weekend availability Supplemental pay types: - Overtime pay - Performance bonus - Shift allowance Ability to commute/relocate: - Navi Mumbai, Maharashtra: Reliably commute or planning to relocate before...

  • IT Auditor

    3 weeks ago


    mumbai, India Skill Ventory Full time

    Roles and Responsibilities We are hiring for IT Auditor - Shadow Light IT Reviewer team at leading investment bank based in Mumbai Knowledgeable with common end user applications; Office and associated macros, Javascript, CSharp, VB Scripts, .Net, etc. Extended knowledge of IT Security Risk Management concepts and with good understanding of industry...

  • Ethical Auditor

    6 days ago


    mumbai, India QIMA Full time

    Job DescriptionThis is a full-time on-site role located in Mumbai for an Ethical Auditor (CSCA). The Ethical Auditor will be responsible for conducting ethical audits at factories, suppliers, and other facilities to ensure compliance with ethical standards, laws, and regulations. Additionally, the Ethical Auditor will be responsible for preparing audit...

  • Ethical Auditor

    7 days ago


    Mumbai, India QIMA Full time

    Job DescriptionThis is a full-time on-site role located in Mumbai for an Ethical Auditor (CSCA). The Ethical Auditor will be responsible for conducting ethical audits at factories, suppliers, and other facilities to ensure compliance with ethical standards, laws, and regulations. Additionally, the Ethical Auditor will be responsible for preparing audit...