Submission & Resubmission Officer

Role Overview

Submission & Resubmission Officer at NMC Healthcare. This role manages the accurate and timely submission of medical claims and oversees the resubmission process for rejected or denied claims.

Role Purpose

To ensure claims and required documentation are submitted accurately and within established timelines, investigate and resolve rejections and denials, and drive continuous improvement in claim acceptance rates and revenue cycle performance.

Key Responsibilities

Claims Submission & Processing

• Submit claims and required documentation accurately and within established timelines.
• Verify claim completeness, coding, and supporting documentation before submission.
• Review rejected or denied claims and prepare resubmissions after correcting identified issues.

Claims Monitoring & Investigation

• Monitor claim status and follow up on pending, rejected, or returned claims.
• Investigate rejection and denial reasons and coordinate with relevant departments to resolve issues.
• Escalate complex or recurring issues to the Team Lead or Manager.

Compliance & Communication

• Ensure compliance with payer guidelines, company policies, and regulatory requirements.
• Communicate with insurance companies, third-party administrators (TPAs), and internal stakeholders regarding claim status and requirements.
• Stay updated on changes in payer requirements, coding guidelines, and submission processes.

Records & Reporting

• Maintain accurate records of submissions, resubmissions, and claim outcomes.
• Prepare daily, weekly, and monthly reports on submission activities, rejection trends, and resubmission performance.

Continuous Improvement

• Participate in quality improvement initiatives to reduce rejection rates and improve first-pass claim acceptance.

Qualifications & Experience

• Bachelor's degree or diploma in Healthcare Administration, Medical Records, Business Administration, or a related field.
• 1–3 years of experience in medical claims submission, revenue cycle management, or healthcare operations.
• Familiarity with insurance claim processing and payer requirements is preferred.