Job Description

Essential Job functions and Key Accountabilities:
Denial Intelligence & Root Cause Analysis (35%)

• Maintain a single source of truth for all denial data by payer, denial code, service line, provider, CPT/DRG/HCPCS/Drugs and point of origin.
• Classify every denial as preventable or non-preventable and assign a point of failure: Registration, Eligibility, Authorization, Clinical Documentation, Coding, Billing or Payer Error.

Prevention Design & Implementation (25%)

• Convert RCA findings into permanent controls: system edits, HIS/EMR hard stops, worklist rules, checklists and pre-submission scrubber logic.
• Partner with IT/HIS to build and test claim-scrubber edits; validate every edit post-deployment for false-positive rate and actual denial reduction.
• 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.

Cross-Functional Partnership & Education (20%)

• 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.
• Develop job aids, quick-reference guides and pre-service checklists for frontline staff.
• Act as the RCM point of contact for physicians on documentation sufficiency for medical necessity denials.

Reporting, Dashboards & Governance (15%)

• Produce the monthly Denial Prevention Scorecard for RCM leadership showing trend, target, variance and corrective action status.
• Maintain live dashboards covering denial rate, clean claim rate, preventable denial value and prevention initiative progress.
• Prepare quarterly business reviews with payer-level denial evidence to support contract discussions and payer escalations.

Regulatory & Compliance Alignment (5%)

• Ensure all prevention controls comply with DOH Abu Dhabi standards, Shafafiya/Riayati submission requirements and payer contractual terms.
• Ensure no prevention initiative creates coding compliance risk; escalate any proposal to alter coding for reimbursement advantage.

Technical Competencies

• Strong understanding of: UAE insurance systems (Thiqa, Daman, private payers), pre-authorization and claims processes, medical terminology and coding basics (ICD/CPT preferred), highly proficient in Microsoft 365 (PowerPoint, Excel & Teams), comfortable using AI-enhanced documentation or analytics tools and analytical ability to assess financial and insurance-related risks.

Qualification

Bachelor’s degree in health information management, Life Sciences, Healthcare Administration, Nursing or equivalent. Active coding certification CPMA, CDIP, CCS or equivalent (AAPC / AHIMA).

Experience

Minimum 5 years in healthcare revenue cycle, including at least 2 years focused on denial management or claims analytics. Demonstrated working knowledge of the UAE payer environment: DOH Abu Dhabi regulations, Shafafiya, Daman and Thiqa adjudication rules, and DOH standard denial codes. Advanced Excel — pivot tables, lookups, Power Query — and the ability to build and maintain analytical dashboards.