Billing and Revenue Recovery Officer-Billing and Recoveries

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JOB DESCRIPTION

Job holder is responsible for the identification, mitigation, and prevention of denials along with preparing reports on clinical disputes based on the criteria documented. Assists with day to day revenue cycle denial operations and supports process improvement initiatives for coding, billing, and collections activities associated with Denial Prevention.

• Monitors compliance with rules, contractual terms, and agreements with insurance companies and DOH Guidelines.
• Ensures compliance by the facility pricing structure and the rules for the different patient categories (including self payer) with implementation.
• Prepares electronic submissions for all patient invoices (claims).
• Maintains and reports incorrect charges and charges not captured to Team Billing Lead or Billing Manager; bills all secondary claims processed daily by billing system.
• Ensures that DRG revisions are billed timely according to billing policy.
• Maintains a high level of productivity while maintaining accuracy.
• Maintains a working knowledge of all universal billing guidelines for assigned payers.
• Assists and works on HCPCS revisions for rebills daily.
• Analyzes and rebills late charges according to current policies.
• Organizes, negotiates, and communicates clinical claim denials with internal clinical staff, financial services, and external claim representatives.
• Participates in external payer meetings, presenting payer performance related to denials.
• Serves as the SME for clinical denials documentation and payer clinical guideline.
• Conducts follow up on claims unpaid, partially paid or denied, including appeals and resubmission to the insurance company.
• Maintains claims documentation.
• Assists in developing reporting mechanisms to identify trends.
• Delivers solutions to simpler issues facing employees and presents complex issues to Senior Billing and Revenue recoveries.
• Corresponds with vendors for account verification and payment details.
• Consults with other disciplines and ancillary departments to obtain documentation for clinical appeal and prevention.
• Promotes effective communication strategies within the team and maintains interdepartmental liaison.
• Works with stakeholders to identify trends leading to inappropriate denial.
• Proactively identifies problems and opportunities for improvements related to system usage, training, and user trends; recommends resolution to Manager of Revenue Recovery.
• Identifies, monitors and presents monthly denial performance with case studies and recommendations for process improvement.
• Responds to verbal and written inquiries in a timely manner.

• Extensive knowledge of healthcare revenue cycle systems.
• Minimum of 5 years of healthcare customer service, claims, denials, appeals, compliance or related experience.
• Strong knowledge of third party payer reimbursement, eligibility verification, and compliance rules.
• Knowledge of medical terminology, CPT, ICD 9, and ICD 10 coding.
• Experience in a large healthcare facility (Desired).
• Experience in training and staff development (Desired).
• Bachelor's degree in Accounting, Finance, Commerce or related field.
• Clinical Coding Certification, BS in Accounting, Finance, Business Administration or Healthcare (Desired).
• Master's in Business Administration or Healthcare preferred.
• Healthcare Certification (FHFMA and/or FACHE) preferred.

Abu Dhabi Healthcare Company (SEHA) is the largest and most comprehensive healthcare network in the UAE with public hospitals and clinics across Abu Dhabi.

SEHA partners with global leaders such as Mayo Clinic and delivers world class healthcare services across its network.

Sheikh Shakhbout Medical City (SSMC) is the largest tertiary hospital in the UAE, a leading hub for integrated patient centric medical services.