Specialist - Medical Audit - National Health Authority

1. POSITIONS VACANT : Specialist (Medical Audit), S-MA, National Health Authority (NHA), MoHFW, GoI (One Vacancy)

2. ORGANIZATION BACKGROUND:

National Health Authority (NHA) is the apex body, responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), India's flagship health assurance scheme, providing health cover of Rs. 5 lakhs per family, per year, for secondary and tertiary care hospitalization, to over 10.74 crore poor and vulnerable families, or approximately 50 crore beneficiaries.

NHA is tasked with implementing PM-JAY at the national level.

State Health Agencies (SHAs) have been instituted by concerned states to implement PM-JAY at the state level. SHAs have full operational autonomy to implement PM-JAY in their state.

Key Functions of NHA

Key functions of the NHA include the following:

(1) Formulation of operational guidelines, model documents and contracts, to ensure standardization and interoperability of PM-JAY;

(2) Effective implementation and regular monitoring of PM-JAY, across the country, including initiation of suitable action for course correction, as necessary;

(3) Coordination with various State Governments on a regular basis for implementing PM-JAY;

(4) Acting as an apex body for SHAs that have been set up to implement PM-JAY.

For more information about NHA, please visit https://pmjay.gov.in/about/nha

3. JOB DESCRIPTION/ RESPONSIBILITIES:

Reporting to the General Manager (Operations), the Specialist (Medical Audit) shall be responsible for the following:

Key Responsibilities :

(1) Manage the Fraud Control Unit under NHA which includes setting up and institutionalizing a strong Medical audit framework under PM-JAY;

(2) Manage Advisors and Consultants working in the area of Fraud Control and Medical Audit, apart from ensuring continuous coordination with other divisions under NHA;

(3) Create and strengthen medical audit tools and modules to conduct effective desk and field medical audits;

(4) Conduct field and desk medical audits on a pan-India basis, with a view to detecting any suspicious activity and highlighting the same to concerned SHAs in a timely manner;

(5) Analyse various dashboards, triggers and outliers, to identify cases for medical audit;

(6) Analyse data trends, dashboards and suspect cases referred from triggers and/or identified from other sources;

(7) Work closely with the IT Team to embed fraud triggers, medical protocols, guidelines and medical audit requirements (both concurrent and post facto) into the system;

(8) Provide medical inputs and feedback for strengthening of fraud controls and triggers;

(9) Capacity building of States in the area of medical audit and field investigation;

(10) Guide, mentor, support SHA medical audit teams and oversee their performance;

(11) Conduct joint field medical audits along with State teams;

(12) Any other work that may be assigned by management from time to time.

4. QUALIFICATION, SKILLS AND EXPERIENCE:

Qualifications:

Essential :

(1) Bachelor's Degree from a recognized University/ Institute;

(2) MBA/ PGDHM/ Master's Degree in Hospital Administration/ Public Health from a reputed and recognized university, or institution.

Desirable: Graduate or post degree in medicine shall be an advantage.

Experience:

Essential: Five years of experience in healthcare quality management or assurance, with focus on medical audit.

Desirable:

Prior experience in the health insurance domain shall be an advantage.

Skills and Competencies:

(1) Knowledge of medico-legal clauses;

(2) Strong verbal and written communication and presentation skills;

(3) Computer literate with knowledge and experience of MS Office, Excel and PowerPoint;

(4) Proficient in drafting notes and letters in English and Hindi, with emphasis on spelling, punctuation, grammar, and other language skills;

(5) Language skills in English and Hindi.

5. VACANCY DETAILS: One vacancy

6. AGE LIMIT:

Not less than 30 years and not exceeding 45 years, as on the last date for receiving applications.

7. COMPENSATION OFFERED:

Gross remuneration budgeted for the position is Rs. 1,25,000/- per month.

8. LOCATION: New Delhi, NHA Office.

9. CONTRACT TYPE AND PERIOD:

The post-holder shall be engaged on a consultancy contract, initially for a period of 12 months, extendable thereafter, on the basis of performance and approval by NHA.

10. REFERENCE: S-MA

11. CONTACT INFORMATION:

Team SAMS
Strategic Alliance Management Services P Ltd.
1/1B, Choudhary Hetram House, Bharat Nagar
New Friends Colony, New Delhi 110 025
Phone Nos.: 011-41011564/65; 4081 990

12. LAST DATE FOR APPLICATIONS:

Eligible candidates interested in this position are requested to apply online at www.sams.co.in by or before August 16, 2020, 11:59:59 PM.

CORRIGENDUM :

The last date for receipt of completed application forms for the vacancy is extended up to August 16, 2020 (11:59:59 PM). Other terms and conditions related to the application process remain unchanged.

Please Note : Only information input by candidates into their online application form, shall be considered for the purposes of confirming eligibility and assessing their candidature. The CV document uploaded by candidates shall be considered to comprise supplementary information, only. Requests by candidates to consider supplementary information provided in the CV document for the purposes of determining eligibility or awarding assessment scores shall not be entertained. Applications submitted through non-online modes, shall be deemed invalid.