Case Manager

Identify missing clinical data and communicate directly with the attending physician for timely completion.

Validate clinical evidence to ensure services meet medical necessity criteria.

Ensure case documentation accurately captures patient risk to justify the optimal case mix.

Review outpatient records to verify adherence to current E&M documentation guidelines.

Prevent down-coding and missed revenue leakages by ensuring all services rendered are coded accurately.

Analyze the root causes of insurance claim rejections.

Execute random file audits across different departments to identify trends and systemic errors.

Provide actionable feedback and training to healthcare providers to prevent recurring denials.

4. Provider Education

Advise doctors and departments on best-practice trends, optimal resource utilization, and controlling outlier expenses.

Create training modules aimed at correcting recurring billing errors and documentation weaknesses

OSH ROLES AND RESPONSIBLITIES
:

GENERAL:

• Responsible for implementation of OSHAD-SF& NMCSH Al Ain Internal OSHMS/ OSHMS /EHSMS policies and procedures/SOP’s relevant to their department.
• Should notify/report all OSHMS/EHSMS hazards, incidents, accidents and near misses within the premises of NMCSH Al Ain to their supervisor or department OSH Facilitator as per the incident reporting protocol of NMCSH Al Ain.
• Should familiarize them and comply with all NMCSH Al Ain OSHMS /EHSMS policies, standards and procedures that are relevant for their workplace.
• Responsible to attend applicable department OSHMS /EHSMS training and follow NMCSH Al Ain policies and procedures.
• Responsible for taking reasonable care for their health and safety of persons and the Occupational that may affect by the labor act or omissions at the workplace.
• Responsible to wear all PPE’s provided to them.
• Staff is not allowed to tamper or misuse any NMCSH Al Ain equipment’s and its property.
• Should abide all safety instructions and signages within the premises of NMCSH-Al Ain.
• Responsible for following and complying with any specified OSH/EHS procedures associated to the task/job.

Specific:

• Lead the development of appropriate OSH management system.
• The ultimate responsibility for Occupational, Health and Safety within all facilities of NMCSH, Al Ain.
• Shall allocate adequate resources for OSH management ( e.g. Budget , human resources, equipment’s)
• The GM approves and endorses NMCSH, Al Ain EHSMS/OSH Policies and Procedures/Programs /Plan.

3.52 Sets and approves a clear OSH Policy for NMCSH, Al Ain. Ensure that the OSH policy is reviewed annually.

• Identify missing clinical documentation and liaise with attending physicians for timely completion.
• Validate clinical evidence to ensure compliance with medical necessity requirements.
• Ensure accurate documentation to support patient risk adjustment and optimal case mix.
• Review outpatient medical records for compliance with current Evaluation & Management (E&M) documentation guidelines.
• Ensure accurate coding of all services to prevent down-coding and revenue leakage.
• Analyze the root causes of insurance claim rejections and denials.
• Conduct random audits of medical records across departments to identify trends and documentation gaps.
• Recommend corrective actions to minimize recurring claim denials.
• Support billing optimization through accurate documentation and coding practices.

• Educate physicians and clinical departments on documentation and coding best practices.
• Develop and deliver training programmers to address recurring documentation and billing errors.
• Promote appropriate resource utilization and reduction of unnecessary costs.
• Provide continuous feedback to improve clinical documentation quality and coding accuracy.

• Implement and comply with OSHAD-SF and NMC Al Ain Occupational Safety & Health Management System (OSHMS/EHSMS) policies, procedures and SOPs.
• Report all hazards, incidents, accidents and near misses in accordance with the incident reporting protocol.
• Comply with all applicable…