Submission & Resubmission Officer
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Key skills for this role
About the Role
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 fol.
Key Skills for This Role
Responsibilities
- Review and audit medical claims to ensure accuracy
- Handle resubmission of rejected claims
- Ensure agreed price list and provider manual are followed for billing
- Update billing officers on rejections and corrective actions
- Follow up with doctors for claim justification when necessary
- Submit claims with proper codes and format to insurance companies within stipulated time
- Comply with OSH and infection control policies
Requirements
- Experience in medical claims processing and resubmission
- Knowledge of medical coding and insurance billing
- Familiarity with insurance company price lists and provider manuals
- Strong attention to detail and accuracy
- Ability to follow up with doctors for claim justification
Full Job Posting
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.
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