Vice President External Medical Audit Daman Abu Dhabi

Daman – National Health Insurance Company is seeking a Vice President External Medical Audit in Abu Dhabi. This job opportunity was published by the company on January 29, 2024 and is now open for applications. If you’re interested in this role, submit your online application now.

Duties as Vice President External Medical Audit

• Strategic Oversight: Develop and implement strategies for medical investigations and audits, aligning them with organizational goals and regulatory requirements.
• Leadership & Management: Lead a team of professionals responsible for conducting investigations, and audits. Provide timely feedback, mentorship, guidance, and direction to ensure optimal team performance and professional development.
• Regulatory Compliance: Stay abreast of healthcare regulations, policies, and laws to ensure adherence across auditing operations. Develop and revise protocols to meet changing regulatory landscapes.
• Audit Procedures: Design and execute comprehensive audit procedures to assess the effectiveness and compliance of medical billing, necessity, documentation, and quality standards.
• Team Performance Analysis: Provide continuous oversight of team performance. Establish and adjust KPI’s to continuously move the team to the next level. Be continuously ready to present results and findings to relevant stakeholders.
• Risk Management: Identify potential risks related to the audit function and team performance, implement risk mitigation strategies, and establish proactive measures to prevent future issues.
• Collaboration: Work closely with cross-functional teams, including but not limited to Legal, Claims, Medical Governance, Authorization, Provider Networks, and Executive Leadership. Implement corrective actions, policies, and training programs based on investigation and audit outcomes.
• Continuous Improvement: Drive a culture of continuous improvement by identifying areas for enhancement in procedures, protocols, and organizational practices.

Qualifications & Experience

Following are the requirements for the role of Vice President External Medical Audit at Daman:

• Bachelor degree in Medicine, Healthcare Administration, Business, or related field.
• Extensive experience (8+ years) in healthcare/insurance auditing, investigations, or a related field.
• At least 5 or more years of demonstrated team leadership.
• A track record of implementing successful strategies for auditing and/or investigations and improving operational effectiveness in organizational settings.
• Coding or auditing certifications highly desired.
• Licensed clinicians also advantageous.

Knowledge & Competencies

•  Strong knowledge of healthcare regulations, ethical standards, and auditing best practices.
• Proven leadership skills with experience managing and leading teams in a complex healthcare environment.
• Excellent analytical, execution, problem solving, and decision-making skills.
• High level of communication and presentation abilities.
• Good command of written and spoken English; knowledge of Arabic language is an advantage.
• Flexible and able to work under pressure
• Respect and maintain a high-level confidentiality.
• Proactive and results oriented whilst ensuring high quality of work.
• Advance level of customer service orientation and professionalism in all interactions.
• Able to work in a multi-cultural environment and promote teamwork and knowledge sharing in order to achieve goals and deliverables.
• High level knowledge of Microsoft applications.
• Very good knowledge of claims processing concepts, clinical coding systems and other related IT Solutions.
• Strong knowledge of healthcare regulations, ethical standards, and auditing best practices.
• Proven leadership skills with experience managing and leading teams in a complex healthcare environment.
• Excellent analytical, execution, problem solving, and decision-making skills.

Vice President Medical Cost Optimization Daman Abu Dhabi