Clinical Denials Specialist
4 days ago
About the Job
We are seeking a skilled Clinical Denials Specialist to join our team at Sheikh Shakhbout Medical City (SSMC). As a Clinical Denials Specialist, you will play a vital role in identifying, mitigating, and preventing denials, as well as preparing reports on clinical disputes based on documented criteria. You will assist with day-to-day revenue cycle denial operations and support process improvement initiatives for coding, billing, and collections activities associated with denial prevention.
Responsibilities:
- Monitor Compliance: Ensure compliance with rules and contractual terms and agreements with insurance companies and DOH guidelines.
- Denial Prevention: Assist with daily revenue cycle denial operations and support process improvement initiatives for coding, billing, and collections activities.
- Billing and Claims: Prepare submission for all patient invoices electronically, maintain and report incorrect charges and charges not captured, and bill secondary claims processed on a daily basis.
- Productivity and Accuracy: Maintain a high level of productivity while maintaining accuracy, and analyze and rebill late charges according to current policies.
- Payer Meetings: Participate in external payer meetings, presenting payer performance related to denials, and serve as the Subject Matter Expert (SME) for clinical denials documentation and payer clinical guidelines.
- Claims Documentation: Maintain claims documentation, conduct follow-up on claims unpaid, partially paid or denied, including appeals and resubmission to the insurance company, and promote effective communication strategies within the team.
- Training and Development: Identify, monitor, and present monthly denial performance accompanied with case studies and recommendations for process improvement, and respond to verbal and written inquiries in a timely manner.
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Abu Dhabi, Abu Dhabi, United Arab Emirates Sheikh Shakhbout Medical City - SSMC Full timeJOB DESCRIPTIONJob holder is responsible for the identification, mitigation, and prevention of denials along with preparing reports on clinical disputes based on the criteria documented. Assists with day-to-day revenue cycle denial operations and support process improvement initiatives for coding, billing, and collections activities associated with Denial...
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Abu Dhabi, Abu Dhabi, United Arab Emirates Sheikh Shakhbout Medical City - SSMC Full timeJOB DESCRIPTIONJob holder is responsible for the identification, mitigation, and prevention of denials along with preparing reports on clinical disputes based on the criteria documented. Assists with day-to-day revenue cycle denial operations and support process improvement initiatives for coding, billing, and collections activities associated with Denial...
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