Submission & Resubmission Officer

Role Overview

Submission & Resubmission Officer at NMC Healthcare.

Role Purpose

Review, audit, and manage the resubmission of medical claims to ensure accuracy, completeness, and compliance with insurance payer requirements, while maintaining timely communication with billing teams and clinical staff.

Key Responsibilities

Claims Review & Audit

• Review and audit medical claims to ensure accuracy and completeness.
• Submit claims with proper codes and format to insurance companies within the stipulated time.

Claims Resubmission & Management

• Resubmit rejected claims in line with payer requirements.
• Handle the resubmission of rejected claims and manage resubmission of rejected claims.
• Coordinate resubmission of rejected claims with follow-up actions.

Payer Compliance

• Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.

Stakeholder Coordination

• Follow up with respective doctors for justifying the claims if necessary.
• Coordinate with physicians for justification where required.
• Prepare claims for resubmission after obtaining necessary documentation.
• Ensure that billing officers are updated on time with rejections and corrective action is taken to avoid such instances in future.

Qualifications & Experience

• Medical or Nursing graduate from a recognized university.
• Experience in insurance claims resubmission.
• Medical coding experience is preferred.

Skills & Competencies

• Excellent command of spoken and written English.