Denials and Reconciliation Manager

Job Description

Basic Purpose of the role

The Denials and Reconciliation Manager is responsible for managing denied medical claims and ensuring accurate and timely reconciliation of payments from insurance providers and third-party payers. This role plays a crucial part in minimizing revenue leakage, ensuring compliance with Department of Health – Abu Dhabi (DoH) regulations, and improving the overall efficiency and transparency of the revenue cycle process.

Key responsibilities of the role

• Lead the full cycle of denial management, including identification, categorization, appeal submission, and resolution.
• Analyse trends in denials to identify root causes (e.g., eligibility issues, coding errors, authorization problems).
• Develop and implement denial prevention strategies across departments (e.g., front desk, coding, authorization).
• Ensure all appeals are submitted with appropriate clinical documentation and in compliance with payer-specific requirements (e.g., DAMAN, Thiqa, ADNIC).
• Coordinate with CDI, HIM, front office and clinical teams to address documentation gaps contributing to denials.
• Monitor denial turnaround times, appeal success rates, and recovery metrics.
• Oversee reconciliation of claims remittances, negotiate with payers with expected payments.
• Ensure compliance with DoH-Abu Dhabi regulations, insurance policies, and claim audit standards.
• Develop and maintain SOPs for denial management and reconciliation workflows.
• Prepare regular reports for senior leadership on denial trends, recovery amounts, reconciliation status, and KPIs.
• Support internal and external audits by providing required documentation and justification.
• Lead, train, and supervise a team of denial analysts, reconciliation officers, and revenue cycle staff.
• Conduct periodic performance evaluations and support professional development.
• Collaborate with IT, clinical departments, and insurance coordination teams to optimize workflows.

Participate in system upgrades, claim system testing, and process enhancement projects.

Other responsibilities

• Concentrate for extended lengths of time
• Tolerate frequent interruptions and accommodate readily to changing work priorities.
• Readily and effectively communicate with others, both verbally and in writing.
• Good command in written and spoken English, Arabic fluency is an advantage.
• Presentable and pleasing personality
• Proactive and approachable

Required physical activities to include standing, walking,

Compliance guidelines

Facilitates effective communication between the patient, family and the interdisciplinary health care team as required.

Demonstrates improvement in clinical practice as a result of application of new theoretical knowledge and technology.

Actively participates in the annual system of performance review.

Qualifications, Certifications and Experience

Education: Master/Bachelor Degree in Nursing or any equivalent Science Degree. Coding certificate is an advantage.

Experience: Minimum of 5 years of experience in denial management and reconciliation process in Abu Dhabi Market.

Physical requirements

The position requires a considerable amount of physical work. The individual must be able to quickly maneuver throughout halls, stairways and patient rooms in response to hospital emergencies. The following denote the key physical requirements for the job, which may require: Standing, Simple Grasping, Fine Manipulation, Operation Machinery / Equipment, Lifting / overhead reaching, Twisting, Climbing / Balancing, Crouching / Squatting, Reaching and Manual handling of people of approximately 100kg.  Lifting equipment must be used whenever practicable.

In addition, the position requires office work involving extensive use of the computer and interdepartmental coordination. Typical physical demands include: a high degree of manual dexterity to sufficiently perform computer functions on a keyboard, produce materials on a PC and operate basic office equipment, normal or corrected vision and hearing, extensive sitting and walking, mobility sufficient to visit with departments or employees throughout the facility and lift up to 13 kgs.

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