Denial Management Officer (STMC)

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.

Qualification :-

Special Certificate:-

Required:
• A minimum of (3) years of healthcare customer service, claims, denials, appeals, compliance, or related experience is required.
• Ability to communicate with multiple levels in the organization (e.g. managers, clinical, and support staff);
• Excellent organizational skills including effective time management, priority setting, and process improvement;
• Understands the difference in billing, collections, payments, and refunds from payors;
• Possess an understanding of accounts receivables and claim denials;
• Knowledgeable and/or previous experience in Recovery Audits and payor audit processes;
• Clear concise verbal and written communication skills;
• Computer experience in Microsoft Office (Word and Excel);
• Knowledge of general medical terminology, CPT, ICD-9, and ICD-10 coding.
• Extensive knowledge of healthcare revenue cycle systems;
• 4 years of experience in registration, billing, and denial prevention environment-related fields or front-end access-related fields;
• Strong knowledge of third-party payor reimbursement, eligibility verification process, and government and payor compliance rules

Desired: