Group Auditor  Full Time NEW

Group Auditor – IP Coding performs detailed audits of inpatient cases, including documentation, coding, charge capture, medical necessity, LOS justification, and DRG placement. The role evaluates adherence to UAE payer rules, DRG guidelines, and internal standards across multiple hospitals. The Auditor collaborates closely with coding, CDI, revenue integrity, case management, and clinical teams to communicate findings, drive corrective actions, and monitor improvements. The position also supports external audit preparedness, internal risk mitigation, and enterprise-wide compliance initiatives.

The post holder will:

• 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/documentation gaps leading to reduced reimbursement.
• 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.
• 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
• Stay informed of changes in UAE healthcare regulations, payer policies, and compliance standards to keep audit procedures current

Education and Certification: Bachelor’s degree in nursing, Life Sciences, Health Information Management, or Healthcare Administration. Holding valid Coding certification ( AAPC or AHIMA)

Knowledge and Skills:

• 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.

Experience:

• DRG validation and severity level evaluation
• Medical necessity and LOS audits
• High-cost drug, device, and procedure justification
• Denial root-cause analysis & compliance reporting
• Revenue leakage detection in inpatient settings
• Clinical documentation review & CDI alignment
• Minimum 4–6 years in inpatient coding/auditing or RCM operations within a UAE healthcare organization.