Submission & Resubmission Officer
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About the Role
3.1 Review and A udit Medical Claims to ensure their accuracy. 3.
Key Skills for This Role
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Overview
- 3.1 Review and A udit Medical Claims to ensure their accuracy.
- 3.2 Resubmission of rejected claims.
- 3.4 Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
- 3.5 Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.
- 3.6 Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
- 3.7 Submit the claims with proper codes and format to insurance companies within the stipulated time.
- Review and audit medical claims to ensure accuracy and completeness.
- Manage the resubmission of rejected claims in line with payer requirements.
- 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.
- Coordinate resubmission of rejected claims, including follow-up with physicians for justification where required, and prepare claims for resubmission.
- Submit claims with accurate coding and proper formatting to insurance companies within stipulated timelines.
- Medical or Nursing graduate from a recognized university.
- Experience in insurance claims resubmission.
- Medical coding experience is preferred.
- Excellent command of spoken and written English.
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