Submission & Resubmission Officer

Role Overview

Submission & Resubmission Officer at NMC Healthcare. The role is responsible for filing and tracking insurance claims, informing patients of their claims status, processing insurance and disability claims in a timely manner, and preparing insurance forms and associated correspondences.

Role Purpose

To manage the submission and resubmission of insurance claims, ensure accuracy and compliance with payer requirements, maintain timely communication with patients and internal stakeholders, and support the organization's operational and safety standards.

Key Responsibilities

Claims Management & Processing

• Review and audit medical claims to ensure their accuracy.
• Resubmit rejected claims.
• Handle the resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary, and prepare them for resubmission.
• Submit claims with proper codes and format to insurance companies within the stipulated time.
• Process insurance and disability claims in a timely manner.
• Prepare insurance forms and associated correspondences.

Billing Compliance & Provider Relations

• Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
• Ensure that the billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.

Patient Communication

• Inform patients of their claims status.

Occupational Safety & Health

• Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply with those requirements.
• Work in accordance with the documented OSH procedures and instructions and specific responsibilities.
• Be familiar with emergency and evacuation procedures.
• Notify OSH hazards, incidents, near misses and issues and assist with the preparation of risk assessments and incident reports.
• Comply with waste management procedures and policies.
• Attend applicable OSH and infection control training programs, mock drills and awareness programs.
• Use appropriate personal protective equipment and safety systems.
• Ensure that employees follow applicable OSH and infection control policies, procedures and standards.
• Provide OSH information, training and supervision to staff.
• Report any OSH-related incidents, near misses, and hazards in the department in a timely manner.
• Ensure that incident corrective actions have been implemented.
• Assist with preparation of risk assessments and monitoring control measures.

Training & Development

• Ensure that trainings are conducted, including general, departmental, FMS, and OSH orientation for new employees and transferred employees, and refresher training for department staff.

General Duties

• Perform any other jobs or duties assigned by the HOD from time to time within the scope of job title.

Qualifications & Experience

• Medical or paramedical graduate (nursing, pharmacy, etc.) from a recognized university.
• Minimum 2 years of experience in insurance claims management and adjudication.
• Experience in medical coding is preferable.

Skills & Competencies

• Excellent command of oral and written English.