Submission & Resubmission Officer
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Key skills for this role
About the Role
Review and audit medical claims for accuracy, manage resubmissions, ensure compliance with billing guidelines, and submit claims timely with proper coding.
Key Skills for This Role
Responsibilities
- Review and audit medical claims to ensure accuracy
- Manage resubmission of rejected claims
- Ensure adherence to agreed price lists and insurance provider manuals
- Update billing officers on claim rejections and corrective actions
- Submit claims with proper coding and formatting within stipulated timelines
Requirements
- Experience in medical claims review and audit
- Knowledge of insurance provider manuals and price lists
- Ability to handle resubmission of rejected claims
Full Job Posting
Job Overview
- 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.
Responsibilities
- Review and audit medical claims to ensure accuracy.
- Manage resubmission of rejected claims.
- Ensure adherence to agreed price lists and insurance provider manuals for accurate billing to respective payers.
- Update billing officers promptly on claim rejections and ensure corrective actions are implemented to prevent recurrence.
- Handle resubmission of rejected claims, including follow up with doctors for justification where necessary and preparation of claims for resubmission.
- Submit claims with proper coding and formatting to insurance companies within stipulated timelines.
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