Job Description

Ensure that every claim submitted by Kanad Hospital is fully accounted for paid, short-paid, denied or pending and that cash received reconciles accurately to payer remittance advice and to the bank. The role exists to make revenue visible, to convert identified variances into recovered cash, and to guarantee that no collectable revenue is lost to timely-filing expiry.

Essential Job functions and Key Accountabilities:

• Validate payer remittance advice (XML / RA) from Shafafiya and TPA portals against submitted claims in the HIS / billing system.
• Post payments, contractual adjustments, patient shares and approved write-offs using correct and consistent reason codes.
• Reconcile bank credits to payer remittances; investigate and clear unapplied and unidentified cash within the month of receipt.
• Identify short-payments and contract-rate variances; quantify, log and escalate each to the Finance Team with complete supporting evidence.
• Track missing remittances and unacknowledged submissions, following up with payer relations until each item is closed.
• Monitor resubmission and appeal windows, handing eligible claims to the denial management team before the window expires.
• Maintain accounts receivable aging by payer, aging bucket and service line; produce the monthly reconciliation and collection pack.
• Feed root-cause data authorisation, eligibility, coding and documentation failures back to front-end teams to prevent recurrence.
• Support RCM external audits with extraction of relevant medical records and a complete claim audit trail.
• Support internal and external audits with reconciled ledgers and a complete audit trail.

Competency Standards

Technical Competencies:

• Analytical rigour reconciles to the dirham and investigates variances rather than writing them off.
• Attention to detail under volume pressure; accuracy is not traded for speed.
• Evidence-based communication with payers and internal stakeholders.
• Integrity and confidentiality in handling patient financial and clinical information.
• Ownership — pursues open items to closure without prompting.

Qualification

Bachelor’s degree in Commerce, Accounting, Healthcare Administration or a related discipline.

Experience

Minimum 3-5 years revenue cycle experience within a UAE healthcare provider. Working knowledge of DOH / Shafafiya submission and remittance standards. Demonstrated experience with Daman, Thiqa and the major TPAs — NAS, NextCare, Neuron and Mednet. Advanced Excel: pivot tables, lookup functions and reconciliation workbooks. Proficiency in a hospital information / billing system.