Billing and Revenue Recovery Officer-Longevity Clinic – Admin

Sheikh Shakhbout Medical City - SSMC; Abu Dhabi; On-site; AED 60,000 - 120,000; Full time

Job summary

A leading healthcare facility in Abu Dhabi is seeking a Revenue Cycle Coordinator. The role involves managing claims, ensuring compliance with healthcare regulations, and improving denial prevention strategies. Candidates should have at least 5 years of relevant experience and a Bachelor's degree in a related field. Knowledge of healthcare revenue systems and coding is essential. The position offers a dynamic work environment and opportunities for professional growth.

Qualifications

• Minimum of 5 years of healthcare customer service, claims, denials, appeals experience.
• Strong knowledge of compliance rules.
• Experience in a large healthcare facility is desired.

Responsibilities

• Monitor compliance with insurance guidelines.
• Prepare submissions for patient invoices electronically.
• Follow up on unpaid or denied claims.

Skills

Healthcare revenue cycle systems

CPT, ICD-9, and ICD-10 coding

Claims management

Third-party payer reimbursement

Education

Bachelor's degree in Accounting, Finance, or Commerce

Job description

JOB DESCRIPTION

Job 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 supports process improvement initiatives for coding, billing, and collections activities associated with Denial Prevention.

RESPONSIBILITIES

• Monitors compliance with rules, contractual terms, and agreements with insurance companies and DOH Guidelines.
• Ensures compliance of facility pricing structure and rules for different patient categories (including self-payer).
• Prepares submissions for all patient invoices (Claims) electronically.
• Maintains and reports incorrect charges and charges not captured to the Team Billing Lead or Billing Manager. Bills all secondary claims processed daily by the billing system.
• Ensures timely billing of DRG revisions according to billing policy.
• Maintains high productivity while ensuring accuracy.
• Maintains knowledge of universal billing guidelines for all assigned payers.
• Assists with HCPCS revisions for rebills daily.
• Analyzes and rebills late charges, adhering to current policies.
• Organizes, negotiates, and communicates clinical claim denials with internal clinical staff, the financial services department, and external claims representatives of insurers.
• Participates in external payer meetings, presenting payer performance related to denials.
• Serves as the Subject Matter Expert (SME) for clinical denials documentation and payer clinical guidelines.
• Follows up on unpaid, partially paid, or denied claims, including appeals and resubmissions.
• Maintains claims documentation.
• Assists in developing reporting mechanisms to identify trends.
• Provides solutions to simple issues and escalates complex issues to the Senior Billing and Revenue Recovery team.
• Corresponds with vendors for account verification and payment details.
• Consults with other disciplines and departments to obtain necessary documentation for clinical appeals and prevention strategies.
• Promotes effective communication within the team and maintains interdepartmental liaison.
• Works with stakeholders to identify trends leading to inappropriate denials.
• Proactively identifies problems and opportunities for system, training, and practice improvements, making recommendations to the Manager of Revenue Recovery.
• Monitors and presents monthly denial performance, including case studies and improvement recommendations.
• Responds promptly to verbal and written inquiries.

Accountabilities

• Maintains and creates invoices and billing materials for customers or patients, ensuring payment history and financial data are accurate.

QUALIFICATIONS

Experience:

Required:

• Extensive knowledge of healthcare revenue cycle systems.
• Minimum of 5 years of healthcare customer service, claims, denials, appeals, compliance, or related experience.
• Strong knowledge of third-party payer reimbursement, eligibility verification, and compliance rules.
• Knowledge of medical terminology, CPT, ICD-9, and ICD-10 coding.

Desired:

• Experience in a large healthcare facility.
• Experience in training and staff development.

Educational Qualification:
Required:

• Bachelor's degree in Accounting, Finance, or Commerce or relevant field.

Desired:

• Clinical Coding Certification, BS in related fields, or Master's in Business Administration or Healthcare.
• Healthcare Certification (FHFMA and/or FACHE) preferred.