Submission & Resubmission Officer

Role Overview

Submission & Resubmission Officer at NMC Healthcare. The role is responsible for filing and tracking insurance claims and informing patients of their claims status.

Role Purpose

To ensure accurate and timely processing, review, and resubmission of medical insurance claims while maintaining compliance with insurance provider requirements and organizational safety standards.

Key Responsibilities

Claims Management

• Review and audit medical claims to ensure accuracy and completeness.
• Handle the resubmission of rejected claims.
• Submit claims with accurate codes and required formats to insurance companies within stipulated timelines.
• Coordinate with respective doctors to obtain necessary justifications for rejected claims and prepare them for resubmission.

Billing Coordination

• Ensure agreed price lists and insurance provider manuals are followed when billing services to respective payers.
• Ensure Billing Officers are promptly informed of claim rejections and corrective actions are implemented to prevent recurrence.

Health, Safety & Compliance

• Comply with all Occupational Safety and Health (OSH) and infection control policies, standards, and procedures.
• Follow documented OSH procedures, instructions, and assigned responsibilities.
• Maintain awareness of emergency and evacuation procedures.
• Report OSH hazards, incidents, near misses, and other safety-related issues promptly.
• Assist in the preparation of risk assessments and incident reports.
• Comply with waste management policies and procedures.
• Attend applicable OSH and infection control training programs, mock drills, and awareness programs.
• Ensure the appropriate use of personal protective equipment (PPE) and safety systems.
• Ensure employees comply with applicable OSH and infection control policies, procedures, and standards.
• Provide OSH-related information, training, and supervision to staff.
• Report departmental OSH-related incidents, near misses, and hazards in a timely manner.
• Ensure corrective actions arising from incidents are properly implemented.
• Assist with the preparation of risk assessments and monitor the effectiveness of control measures.
• Ensure required training programs are conducted, including general, departmental, FMS, and OSH orientation for new and transferred employees, as well as refresher training for departmental staff.

General Duties

• Perform any other duties assigned by the Head of Department within the scope of the job role.

Qualifications & Experience

• Bachelor's degree or equivalent qualification in a Medical or Paramedical field, such as Nursing, Pharmacy, or related disciplines, from a recognized university.
• Minimum 2 years of experience in Insurance Claims Management or Adjudication.
• Experience in Medical Coding is preferred.

Skills & Competencies

• Excellent command of spoken and written English.