Denial Prevention & RCA Specialist

Kanad Hospital; Abu Dhabi; On-site; AED 350,000 - 600,000; Full time

Job summary

Kanad Hospital in Abu Dhabi is seeking a Denial Intelligence and Root Cause Analysis specialist to lead denial data management and prevention initiatives across payer processes.

You will translate RCA findings into permanent controls, collaborate with IT to implement edits, and maintain the Payer Rule Library for Daman Thiqa and contracted payers. Strong Excel and UAE regulatory knowledge required.

Qualifications

• Bachelor's degree in health information management, life sciences, healthcare administration, nursing or equivalent.
• Active coding certification CPMA, CDIP, CCS or equivalent (AAPC / AHIMA).
• Minimum 5 years in healthcare revenue cycle, including at least 2 years focused on denial management or claims analytics.
• Working knowledge of UAE payer environment: DOH Abu Dhabi regulations, Shafafiya, Daman and Thiqa adjudication rules.
• Advanced Excel pivot tables, lookups, Power Query and the ability to build and maintain analytical dashboards.

Responsibilities

• Maintain a single source of truth for all denial data by payer denial code service line provider CPT DRG HCPCS and point of origin.
• Convert RCA findings into permanent controls system edits HIS EMR hard stops worklist rules checklists and pre-submission scrubber logic.
• Maintain the Payer Rule Library a controlled repository of payer-specific coverage authorization bundling medical necessity and documentation requirements for Daman Thiqa and all contracted payers.
• Deliver data-driven feedback to Patient Access Clinical Departments Coding and Billing always naming the specific behaviour the specific cost in AED and the specific fix.
• Run monthly Denial Prevention Huddles with the top three denial-generating departments publish minutes with actions and closure dates.

Skills

Strong understanding of UAE insurance

Excel / Power Query

Analytical risk assessment

Education

Bachelor's degree in health information management

Active coding certifications (CPMA, CDIP, CCS)

Tools

Microsoft 365 (PowerPoint, Excel, Teams)

Job description

Kanad Hospital in Abu Dhabi is seeking a Denial Intelligence and Root Cause Analysis specialist to lead denial data management and prevention initiatives across payer processes.

You will translate RCA findings into permanent controls, collaborate with IT to implement edits, and maintain the Payer Rule Library for Daman Thiqa and contracted payers. Strong Excel and UAE regulatory knowledge required.