Role Summary:Part of Insurance Relations Management department, ensuring all resubmission prepared and submitted as per TAT of regulator and claims analyzed to optimize resubmission rejection as per agreed KPIs. Accurate and in-depth analysis of rejection for effective resubmission process thereby ensuring maximum revenue, identify discrepancies and resolve the denied claims reaching the optimal target levels.The main responsibility of the role is to resubmit claims with highest quality and to ensure the claims are paid. This requires attention to details as the claims are already rejected previously at submission and is now in the resubmission process for settlement.Key Responsibilities:• Evaluates and ensures that all the medical & technical claims denied or underpaid inappropriately by payers are identified, appealed and reversed as per the set deadlines.• Maintains production goals and quality standards set by the department.• Ensures all claims are resubmitted in compliance with coding, insurance and regulator guideline• Maintains and achieves the set TAT’s.• Provides daily feedback to Team leads on rejection trends, and to avoid it in the future in order to optimize clients’ revenue, conveys such feedback to team leaders for future occurrence• Raises queries to the team leader to get required documents or escalation of concerns.• Analyze denials and perform claim justification for resubmissions as well as provide feedback and recommendations for corrective measures at claim submissions level.• To undertake any additional tasks assigned by the line manager in accordance with operational requirements.

Review patient treatment requests for insurance approval.Submit pre-authorization requests via NPHIES/insurance portals.Follow up with insurers/TPAs for timely approvals.Verify patient insurance coverage and eligibility.Maintain accurate records of pre-auth approvals and rejections.

Role Summary:The RCM/CDI Trainer is directly responsible for batch-wise new recruit training and the planning/execution of training programs for existing RCM and CDI specialists, operating under the supervision of the Training Manager. The role requires the ability to develop training content for both new hires and internal staff, and to coordinate with multiple team leaders to understand organizational knowledge gaps and subsequently design targeted training solutions.Primary Responsibilities:Training Delivery & Assessment: Primarily responsible for training and observing RCM/CDI staff performance against established objectives and recommending focused skills enhancement as needed.New Hire Training: Train new recruits on general RCM principles, CDI methodologies, Qatar-specific billing regulations, documentation requirements, and appropriate client guidelines.Skill Alignment: Coordinate with Team Leads to ensure appropriate allocation of RCM/CDI staff to projects based on their specific skill sets and training outcomes.Gap Analysis & Refresher Training: Proactively work with Management, Quality, and Rejection Analysis teams to identify knowledge gaps and develop necessary refresher, focused, and cross-training programs for existing staff.Content Development: Develop general training modules, instructions, checklists, and visual aids specific to RCM and CDI.Compliance Updates: Remain constantly updated on the various process specifications and regulatory changes within the Qatar healthcare RCM environment.Documentation Management: Amend and revise RCM/CDI training programs based on client and regulatory updates. Maintain frequently updated training materials informed by quality reports, rejection analysis, and operations feedback.Record Keeping: Maintain organized log(s) of all training conducted and monitor progress using Training Need Analysis (TNA) feedback and assessments.Performance Improvement: Develop structured action plans for bottom performers based on quality reports and ensure they successfully ramp up during their learning curve.Methodology: Utilize a variety of training methodologies, techniques, and learning tools to maximize the effectiveness of training programs.Team Development: Conduct specialized training and knowledge checks (Quiz programs) for RCM/CDI auditors, quality analysts, and team leads.System Alignment: Participate in rules engine modification discussions and update training manuals accordingly to reflect system logic and process changes.Key Performance Indicator (KPI):Training Efficiency: Deliver training confidently and manage batches efficiently with high trainee satisfaction scores.Production Readiness: Produce quality RCM/CDI specialists and assist in Operations Ramp up/Go-Live readiness within the agreed-upon timeframe.Proactive Training: Proactively identify RCM/CDI training needs within the organization and design and implement new training programs every quarter.Documentation Compliance: Develop, maintain, and ensure all training manuals and records related to delivery meet both internal quality standards and external audit (e.g., client, regulatory) standards.Attendance/Commitment: Maintain unplanned trainer absence within 3% per month.

Role Summary:Detailed analysis of trends and patterns of rejection during the reconciliation process through evaluation of claims; generation, tallying and maintenance of reconciliation reports for the departments and external and internal communication of the recon data and queries. Overall taking measures to optimize rejection rate and meet individual and departmental KPIs.Key Responsibilities:1. Claims Evaluation and Retrospective Audit:Conduct a thorough evaluation and retrospective audit of claims to accurately categorize recoverable and non-recoverable values based on Payer-Provider agreement and Regulatory Authority-Coding-Documentation-Auditing guidelines. This precision is crucial for effective negotiations with payers.2. Report Generation and Maintenance:Generate and maintain comprehensive reconciliation reports, including summaries, claim-wise breakdowns, and activity-wise analyses in FATORAH RECON format. Regularly update these reports on a monthly basis.3. Optimization of Rejection Rate:Implement measures to optimize the rejection rate for a provider-payer account, aiming for a rate below 5%. Analyze rejection patterns, identify root causes, and proactively introduce corrective measures.4. Claims Verification and Upload:Solely manage the verification and upload of claims designated for reconciliation. Ensure a seamless reconciliation process by overseeing claim accuracy and compiling necessary data.5. External Communication:Facilitate precise and timely communication of essential data between payers and providers, including figures, claim analysis, and sign-offs. Adhere strictly to defined turnaround times (TAT).6. Addressing Reconciliation Challenges:Directly address challenges encountered during reconciliation with concerned parties (e.g., Resubmission/IRM). Proactively take corrective measures to prevent future grievances and refine the reconciliation process.To undertake any additional tasks assigned by the line manager in accordance with operational requirements.

We are looking for Pre Approval Officer in UAE.Responsibilties:Oversee the pre-approval process to ensure all documentation is accurate, complete, and compliant with regulatory standards.Train and mentor team members on best practices in pre-approval procedures and guidelines to enhance overall efficiency.

We are looking for Onsite RCM Manager in UAE.Responsibilities:Lead the revenue cycle management team to optimize billing processes, ensuring maximum reimbursement and minimal denials.Conduct regular audits of financial and operational performance metrics to identify areas for improvement and implement corrective actions.Collaborate with clinical staff and administration to streamline workflows and enhance patient data accuracy for better revenue capture.

We are looking for Re submission officer in UAE.Responsibilties:Review and analyze resubmission requests to ensure compliance with regulatory standards and institutional policies.Collaborate with cross-functional teams to gather necessary documentation and evidence for resubmission cases.Draft comprehensive reports and recommendations that outline the rationale for resubmissions to stakeholders.

Wea re looking for Preapproval officer- inpatient in UAE.Responsibilties:-Evaluate and process preapproval requests for inpatient services, ensuring compliance with insurance requirements and medical necessity.Communicate effectively with healthcare providers to gather necessary documentation and clarify treatment plans for preapproval.Maintain detailed records of all preapproval requests and decisions, ensuring accuracy and confidentiality of patient information.

We are looking for Accountant in UAE.Responsibilties:Prepare and maintain accurate financial statements, ensuring compliance with relevant accounting standards and regulations.Conduct detailed account reconciliations, identifying discrepancies and implementing corrective measures to maintain data integrity.Analyze financial data to identify trends, variances, and opportunities for cost savings, providing actionable insights to management.

We are looking for Coding Officer - IP in UAE.Responsibilities:Accurately assign inpatient records, ensuring compliance with regulatory standards and reimbursement guidelines.Review clinical documentation thoroughly to support coding accuracy and optimize the coding process.Collaborate with healthcare providers to clarify documentation, ensuring that coding reflects the true nature of patient care.

We are looking for Quality Audit in UAE.Responsibilties:-Lead the quality audit team in conducting thorough assessments of processes and systems to ensure compliance with industry standards and regulations.

We are looking for Reconciliation Associates in UAE.Responsibilties:Conduct daily reconciliations of operational and interdepartmental transactions to ensure accuracy and compliance with company standards.Investigate discrepancies in transactions, collaborating with relevant departments to identify root causes and implement corrective measures.

We are looking for Quality Audit Officers – IP in UAE.Responsibilties:Conduct comprehensive audits of inpatient medical records to ensure compliance with healthcare regulations and internal policies.Analyze clinical documentation for accuracy and completeness, identifying areas for improvement to enhance patient care quality.

We are looking for Coding officer in UAE.Responsibilites:Accurately assign codes to outpatient records ensuring compliance with coding guidelines and regulations.Review clinical documentation to ensure it supports the assigned codes, facilitating optimal reimbursement and minimizing claims denials.

We are looking for Preapproval Officers - OP&ED in UAE.Responsibilties:Managing Out-patient Approvals through direct coordination with Insurance companies via phone calls, online and electronic systems (insurance portals)Handling the approvals follow ups, queries and rework on requested claims by adding in appropriate ICDs, providing medical justification and other documents to ensure high score of approvals within facility.Ensuring that billed services are under Insurance coverage and generated bills are with correctInsurance details (Patient name, Member ID and Insurer/Payer IDs).

We are looking for RCM Coordinator in UAE.Responsibilities:Conduct comprehensive revenue cycle assessments to identify inefficiencies and recommend actionable improvements.Collaborate with cross-functional teams to streamline billing processes, ensuring accuracy and compliance with regulations.Monitor key performance indicators (KPIs) related to revenue cycle management, providing regular reports to management.

We are looking for Quality Audit officer in UAE.Responsibilities:Conduct systematic audits of outpatient services to ensure compliance with established quality standards and regulatory requirements.Evaluate patient care processes and outcomes, identifying areas for improvement to enhance service delivery and patient satisfaction.

We are looking for IT Helpdesk in UAE.Responsibilties:-Act as the first point of contact for IT support, efficiently managing incoming requests via phone, email, and chat.Diagnose and troubleshoot hardware and software issues, providing solutions or escalating as necessary to ensure quick resolution.Maintain accurate documentation of support requests, resolutions, and technical procedures in the helpdesk system.

Job Family Summary:Revenue Operations is characterized by consistency of actions, values, methods, measures, principles, expectations and outcomes. It comprises of capacity management, production planning, timely reporting and timely submission to the insurance companies with coordination with the revenue integrity.Role Summary:The CQM Coordinator role is responsible for keep engaging team members in claims process. Identify network issues and communicate with IT to resolve those. Co-ordination with team members to achieve the organizations’ goalPrimary Responsibilities:· Allocation of claims to the team members. Make sure to allocate claims to each team member· Report back to line managers/onsite managers on any type of claims process issues that may affect the process.· Meet the team on regular basis to discuss on challenges in claims process.· Escalate IT on network issues, track those and keep in shared folder to share with management· Monitor CQM process within given TAT with the provider as well with the end user· Gather relevant information to clearly describe and properly escalate issues to supervisors and managers.· Ensure high quality customer service and respect medical and work ethics at all times while conducting daily tasks.· Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner.· Provide all the needed support as advised by the supervisor based on the business need.· Other related tasks assigned by the line manager

Role Summary:The (Senior) Supervisor - Revenue Operations is directly responsible for day-to-day planning, allocation and actual production of claims data entry and coding within shortest possible time, with minimal rework, effort and cost by:(a) Assuming direct responsibility for leading and managing Data Entry function and teams(b) Leading collaboration with CRU and Coding functions. To be successful in this role, the Production Manager must have the ability to forecast claims volume with good precision and proactively adjust capacity to ensure effective utilization of resources.This position reports directly to the Operations Manager Revenue Operations.

Arabic Speaker with 8 to 10 +years of work experience in the healthcare sector, especially Providers in the UAE NB: Preferable Abu Dhabi ExperienceExperience & good working knowledge of RCM [Payer and Regulator guidelines] in the UAEEducation in any healthcare /life science backgroundLeadership and customer service skillsClaims Analysis and presentation skillsValid UAE driving licenseExcellent communication skills in both English and Arabic [written and spoken]