Senior Officer – RCM

Job Description

To ensure the accuracy, compliance, and efficiency of outpatient claims processing by conducting detailed audits, analyzing denials, and identifying resubmission opportunities. The role requires expertise in coding standards, regulatory rules (DOH, DHA, MOH), and best practices for claim management in the UAE healthcare system.

Responsibilities

• Claims Auditing and Analysis:
  • Audit outpatient claims to ensure accuracy in coding, billing, and documentation.
  • Review denied claims to identify root causes and trends (e.g., coding errors, eligibility, medical necessity).
  • Perform audits on processed claims to confirm compliance with DOH, DHA, and MOH guidelines.
  • Ensure proper application of CPT, ICD-10-CM, HCPCS, and other coding standards.
• Denial Analysis and Management:
  • Analyse denial trends and patterns to identify areas for improvement.
  • Collaborate with the coding and resubmission teams to address common denial reasons.
  • Develop and implement strategies for resubmission of denied claims, ensuring maximum reimbursement.
• Coding and Documentation Support
  • Verify the accuracy and completeness of coding (CPT, ICD-10, HCPCS) used in outpatient claims.
  • Provide recommendations and corrections to improve documentation for accurate billing.
  • Work with clinicians and administrative teams to ensure proper documentation practices.
• Training and Process Improvement:
  • Conduct training sessions for teams on claim submission, denial handling, and coding updates.

Qualifications

Education and Certification:

• Bachelor’s degree in a science-related field or Paramedical studies.
• Certification in medical coding (e.g., CPC, CCS) is required

Knowledge and Skills:

• Strong knowledge of UAE healthcare regulatory frameworks (DOH, DHA, MOH).
• Proficiency in coding standards (CPT, ICD-10-CM, HCPCS) and denial codes.
• Experience in analyzing denials and resubmission strategies.
• Familiarity with healthcare billing systems and RCM software.
• Excellent analytical and problem-solving skills.
• Strong communication and interpersonal skills for collaboration and training purposes.

Experience:

• A minimum of 5 years of relevant experience, with at least 3 years in the UAE market