Submission & Resubmission Officer
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Key skills for this role
About the Role
NMC Health plc is hiring a Submission & Resubmission Officer to file and track insurance claims, process resubmissions, and ensure billing accuracy. Requires a medical/paramedical graduate with at least 2 years of experience in insurance claims management and strong English skills.
Key Skills for This Role
Responsibilities
- Review and audit medical claims to ensure their accuracy
- Resubmission of rejected claims
- Ensure that the agreed price list and provider manual from insurance companies are followed for billing
- Ensure that billing officers are updated on time with rejections and corrective actions
- Handle resubmission of rejected claims, follow up with doctors for justification, and prepare for resubmission
- Submit claims with proper codes and format to insurance companies within stipulated time
- Comply with OSH and infection control policies and procedures
Requirements
- Medical/paramedical (nursing, pharmacy, etc.) graduate from a recognized university
- Experience in insurance claims management/adjudication (minimum 2 years)
- Experience in medical coding is preferable
- Excellent command of oral and written English
Full Job Posting
Job Overview
- Resubmission Officer will be responsible for filing and tracking insurance claims and informing patients of their claims status.
- Process insurance and disability claims in a timely manner, prepares insurance forms and associated correspondences.
Key Responsibilities
- Review and audit medical claims to ensure their accuracy.
- Resubmission of rejected claims.
- 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.
- Handling the resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
- Submit the claims with proper codes and format to insurance companies within the stipulated time.
- Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
- 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, specific responsibilities.
- Be familiar with emergency and evacuation procedures.
- Notifying 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.
Requirements
- Medical/paramedical (nursing, pharmacy, etc.) graduate from a recognized university.
- Experience in insurance claims management/adjudication (minimum 2 years).
- Experience in medical coding is preferable.
- Excellent command of oral and written English.
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