Medical Benefits and Auditing Coordinator (For a client of People Dynamics)

Medical Audit Coordinator will report to the Senior Medical Audit Specialist at Medical Services Section and will be performing the following duties:
• Assisting the Senior Medical Audit Specialist and the Head of Medical Services Section in designing and implementing sound policies, processes and procedures to audit Private Health Insurer (PHI), TPA, and Healthcare Providers participating in the Social Health Insurance Scheme (SHI).
• Developing and implementing sound measures that assist in reduction and elimination of fraud, waste and abuse through collaboration with health care providers, Private Health Insurers (PHI) and Third Party Administrators (TPA).
• Reviewing providers’ claims and performing audits as set out in the policy and procedure of the Health Financing and Insurance Department (HFID).
• Coordinating with law enforcement agencies internally and externally in order to develop and execute punitive actions.
• Assisting the Senior Medical Audit Specialist in reviewing priorities.
• With guidance from Manager, Senior Medical Audit Specialist this role will conduct analysis and review work and may provide explanations and interpretations within their area of expertise.

Nature and Scope of the Position:

1. To ensure tasks assigned are completed, providing review of work completed, and certifying that completed work is of a sufficient standard to be issued;
2. To oversee dissemination of relevant briefing materials to bodies who operate within or wish to operate within the SHI Scheme;
3. To oversee collection, organization and storage of relevant and appropriate items of information on regulated bodies, in accordance with the data management standards and other institutions in the country;
4. To develop and submit strategic plans for consideration by the Senior Medical Audit Specialist and prepare and present reports;
5. To work closely with other members of the team to ensure a consistent approach to regulation of the SHI Scheme;
6. To form and maintain relationships with regulated bodies and to be represent at public events, meetings, conferences and seminars; and
7. To form and maintain relationships with senior members of other regulatory agencies across the SHI Scheme.
8. Review results of audit to identify trends and as applicable will bring forth compliance concerns to Audit management.
9. Participate in on-site audits, as needed.
10. Will support Senior Medical Audit Specialist to review data that identifies operational deficiencies and is used to determine corrections that will need to be made to conform to compliance metrics.
11. In preparation for an audit will run reports out of Audit systems which summarize monitoring activities, results and corrections noted and implemented.
12. Under the direction of Senior Medical Audit Specialist will participate in focused audits, as assigned, to identify operational compliance with processes.
13. The incumbent will be making local and international phone calls during and outside of the working hours, as necessary in order to facilitate and expedite outcomes.
14. The incumbent will be attending meetings, conferences and workshops, and give presentations to address any issue related to his/her job, whether within the premises or in any locations within Qatar, or even internationally.