ACCUMED Hiring for Senior Analyst – Business Rules Job at Dubai Full Time

Role Summary:

Senior Business Rules Analyst chiefly responsible for supporting the development for rules content by performing data analytics and extracting insights based on market payers, regulator protocols, claims denial trends and users feedback analysis. To ensure adherence to market billing standards and protocols, the Business Rules Analyst will be expected to work closely with payers, regulators and healthcare providers, revenue cycle departments to analyse coding/billing issues to incompliance with regulatory policies or denials with payers in market of UAE.

Primary Responsibilities:

• 1. Proactive analysis of all payers trend and their claim processing relation with market and business, injecting successful trends in to Rules engine thereby promoting machine learning.
• Monthly analysis and review of claim remittance reports across all the payers and simultaneous provision of feedback suggesting updates for the rule engine thereby decreasing denial trends for the clients and maximising remittance output.
• Regular analysis and review of bypass reports containing feedback from end users to improve the rules logic, quality and accuracy of validation analysis and review of bypass reports containing feedback from end users to improve the rules logic, quality and accuracy of validation outcomes and optimizing end user experience.
• Analysing clients’ historical denial reports establishing their trend analysis and target rules content profile to address their revenue integrity.
• Apply effective communication skills (written and spoken) to communicate with all parties internal and external analysing market insights and best market practice to produce accurate representation of the issues and the proposed solutions in the form of Rules Content definitions.

Job Requirements:

• Minimum 4-5 years’ experience in the claim adjudication lifecycle and payer/TPA is a must.
• Previous work experience with Data Analytics packages such as Power BI will be preferred.
• Excellent Analytical skills and an eye for detail is a must.
• Understanding of insurance adjudication guidelines and protocols in a way to comprehend best to enrich UAE Rules repository.
• Recognised Professional Certification in Medical Coding will be a plus but not mandatory.
• Should be well versed in UAE local market regulations and adjudication protocols.
• Excellent verbal/written communication and presentation skills.
• Proficiency in Healthcare Information Systems
• Medical training as Doctor/Nurse/Pharmacist is highly desirable.