Coder-Denial Prevention Specialist

Denial Intelligence amp 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 amp 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

• 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
• 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
• 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 elevate any proposal to alter coding for reimbursement advantage

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 amp Teams comfortable using AI-enhanced documentation or analytics tools and analytical ability to assess financial and insurance-related risks

• 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. 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.