Billing Auditor

A. Medical Bill Audit

• Review IPD and OPD bills before final submission or discharge.
• Verify billed investigations, procedures, surgeries, medications, consumables, implants, and other clinical services against medical records.
• Ensure that billed services are supported by valid clinical documentation and doctors orders.
• Identify duplicate billing, unbilled services, incorrect quantities, and discrepancies between services provided and services charged.
• Verify compliance with approved hospital tariffs and billing protocols.

B. Clinical Documentation Verification

• Cross-check bills against patient case sheets, treatment charts, investigation reports, medication records, procedure notes, and discharge summaries.
• Verify the medical justification for high-value investigations, procedures, and extended hospital stays.
• Identify missing documentation, incomplete orders, and discrepancies requiring clarification from treating doctors or clinical departments.

C. Insurance and TPA Billing Audit

• Review bills for cashless and reimbursement cases.
• Verify billing as per applicable insurance, TPA, and corporate payer guidelines.
• Identify non-payable items, package deviations, and potential deductions before submission.
• Coordinate with the Insurance and TPA team to resolve queries, deductions, and rejected claims.
• Support accurate and timely preparation of final bills and claim documents.

D. Package and Tariff Compliance

• Audit package-based cases to ensure services are billed according to approved package inclusions and exclusions.
• Identify inappropriate additional charges or missed billable services.
• Verify room category, professional fees, procedure charges, and other applicable billing components.
• Ensure compliance with approved discounts and authorization processes.

E. Coordination and Reporting

• Coordinate with Billing, Medical Records, Pharmacy, Nursing, Clinical Departments, and Insurance teams to resolve discrepancies.
• Escalate significant billing errors, compliance risks, and recurring gaps to the reporting manager.
• Prepare daily or periodic reports on audit observations, billing corrections, deductions, and recoveries.
• Recommend process improvements to minimize revenue leakage and prevent billing errors.