Submission Officer (Corniche Hospital)

Role Overview

Submission Officer at SEHA Hospitals, Corniche Hospital, responsible for managing and monitoring healthcare insurance claims and billing processes to ensure compliance with insurance policies, contractual agreements, and facility pricing guidelines.

Role Purpose

Validate and process inpatient and outpatient claims, resolve rejected or unpaid claims, prepare financial documentation and statements, ensure accurate insurance-related records, provide financial support to patients and clinics, address inquiries, identify and resolve billing issues, and contribute to process improvement initiatives while collaborating with internal teams to enhance operational efficiency and compliance.

Key Responsibilities

Insurance Compliance & Monitoring

• Monitor compliance with insurance company terms and conditions
• Monitor compliance with contractual terms and agreements with insurance companies
• Ensure compliance with facility pricing structure and rules for different patient categories, including self-payers, with implementation

Claims Processing & Validation

• Assist in collecting and processing claims
• Validate claimed outpatient services including Laboratory, Radiology, and Pharmaceuticals
• Check claim invoices for both inpatient and outpatient services
• Generate and regenerate missed and incorrect invoices
• Process each claim in the system
• Follow up on claims submission to the insurance company
• Resubmit rejected claims with wrong reason or without reason and unpaid claims

Financial Documentation & Records

• Prepare statements of accounts
• Ensure all insurance documents are properly filled and claiming-related amounts are verified
• Compare cancelled receipts received from cashiers on a monthly basis to ensure there are no manipulations in canceling transactions

Customer Service & Financial Support

• Respond to verbal and written financial inquiries from patients and Specialty clinics in a timely manner
• Attend to and answer financial matters inquiries from patients and Specialty clinics
• Provide customer service and support

Technical & Problem-Solving Expertise

• Provide technical expertise in identifying potential financial and accounting issues
• Discuss with Manager/Senior Officer, if necessary, before recommending solutions after obtaining and verifying information

Team Contribution

• Participate in cross-functional teams and committees as appropriate
• Serve as a subject matter expert regarding inventory accounts, payments, and accounting systems
• Develop and enhance team procedure manuals and processes in discussion with Manager/Senior Officer

Qualifications & Experience

• Bachelor's Degree or Diploma in a related field (medical/health science)
• AAPC or AHIMA Certification required
• 2–4 years of relevant progressive experience in a similar role required
• Experience in a large healthcare facility desired