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الوصف الوظيفي

The candidate is responsible for the identification, mitigation, and prevention of denials. This position is responsible for preparing clinical disputes based upon evidence base criteria documented within the respective medical record; the Specialist oversees and assists with day-to-day revenue cycle denial operations and supports process improvement initiatives for coding, billing, and collections activities associated with Denial Prevention. The candidate will conduct an analysis of denials and appeals, identifying and presenting both process improvements and revenue protection opportunities. The position will monitor UAE regulatory agencies to maintain up-to-date knowledge of changing rules and regulations affecting denial prevention and management practice. Additionally, will stay abreast of payer clinical policies to dispute denials and provide education for the prevention of denials. The Sr. Revenue Recovery Specialist serves to organize, negotiate, and communicate clinical claim denials with internal clinical staff and the financial services department, as well as external claims representatives of a variety of insurers. In order to optimize the recovery of reimbursement from denied claims and, thereby, enhance the overall financial outcome for SEHA Business Entity, this position manages the claims denial database and provides technical support activities for clinical appeals/audits, including timely medical record releases. This requires timely, articulate direct communication to all stakeholders, with appropriate supporting clinical documentation for unique payer utilization and claims submission requirements. The incumbent supports this activity with SEHA business entities and the Clinical Documentation Integrity. This position further enables financial recovery reporting for SEHA leaders and support for contract negotiation with payers, especially DAMAN.

Abu Dhabi Healthcare Company (SEHA) is the largest and most comprehensive healthcare network in the UAE that was established in 2007 with the objective of operating all public hospitals and clinics across the Emirate of Abu Dhabi.

SEHA is committed to delivering world-class healthcare services using the most advanced diagnostics and systems across its network of public healthcare centers and hospitals in addition to partnering with global leaders in healthcare, including world renowned organizations such as the Mayo Clinic.