Medical Audit - Dubai
1 day ago
Job description
About AuditorXAuditorX is one of the first AI-powered Revenue Control & Denial Prevention frameworks built to transform hospital claims management.
Our mission is to build an intelligent pre-submission claims intelligence layer that enables hospitals to reduce denials, improve reimbursement accuracy, and optimize coding precision before claims reach insurers or TPAs.
As part of our UAE expansion, we are building a Dubai-aligned audit intelligence engine compliant with standards under the Dubai Health Authority and major regional TPAs such as NextCare, NAS Administration Services, and MedNet.
We are looking for a senior Medical Audit & Revenue Intelligence Manager who will play a foundational role in architecting and validating our Dubai claims audit framework.
Role Overview:
This is not a routine claims auditor position.
This role is strategic and product-facing
You will:
Define UAE-specific medical audit rules
Decode insurer deduction patterns
Structure ICD–CPT validation logic
Guide denial prevention frameworks
Support pilot hospital onboarding
Shape the clinical intelligence backbone of AuditorX in the UAE
You will be the bridge between clinical coding, revenue cycle management, and AI-driven automation.
Key Responsibilities:
Claims Audit & Coding Intelligence
Lead validation of ICD-10-AM and CPT coding structures
Define clinical plausibility checks between diagnosis and procedures
Identify coding gaps, undercoding, and overcoding risks
Establish gender and age validation logic for claims screening
Review and benchmark high-value IP and OP claims
Denial Pattern & Payer Behavior Analysis
Analyze common denial and downgrade patterns across Dubai insurers and TPAs
Identify medical necessity weaknesses leading to rejections
Map admission justification logic and LOS reduction trends
Study tariff misalignment and pricing variance risks
Create structured "Top 100 Dubai Audit Edits" framework
Product & Rule Engine Development
Collaborate with tech and analytics teams to:
Design ICD CPT validation rules
Define hard edits vs soft edits
Structure pre-submission risk scoring
Build documentation sufficiency checks
Translate medical audit insights into algorithm-ready logic
Validate PoC claims and refine rule accuracy
Why Join AuditorX
Be part of a category-defining AI healthcare revenue framework
Work at strategy and product architecture level
Shape the UAE market entry of a scalable intelligence platform
High growth leadership opportunity in a structured insurance ecosystem
Important Note
This role requires deep UAE market knowledge.
Candidates without direct Dubai healthcare claims experience will not be considered.
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