Submission & Resubmission Officer
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Key skills for this role
About the Role
NMC Healthcare seeks a Submission & Resubmission Officer to evaluate pre-approval requests, respond to insurance queries, and handle auditing processes. The role requires medical coding knowledge and the ability to work night shifts and public holidays.
Key Skills for This Role
Responsibilities
- Evaluate pre approval requests and code service descriptions according to medical coding rules
- Respond to insurance/TPA queries and liaise with concerned departments
- Receive, evaluate, and escalate second opinion cases and case management
- Prepare reports of daily activity and assist management with monthly reports
- Handle auditing process and arrange documents for external auditors
- Attend meetings and presentations
- Train front office, receptionist, and nurses on insurance details
- Prepare cost estimates for cash patients
- Adjust duties in case of sudden leaves by colleagues
- Manage and hand over pending cases to next shift
Requirements
- Evaluate pre approval requests based on medical necessity and coding rules
- Respond to insurance/TPA queries and liaise with departments
- Handle auditing process and assist external auditors
- Perform night shift duty and work on public holidays
- Train front office, receptionist, and nurses on insurance details
Full Job Posting
Responsibilities
- Evaluate pre approval requests and code service descriptions according to medical coding rules
- Respond to insurance/TPA queries and liaise with concerned departments
- Receive, evaluate, and escalate second opinion cases and case management
- Prepare reports of daily activity and assist management with monthly reports
- Handle auditing process and arrange documents for external auditors
- Attend meetings and presentations
- Train front office, receptionist, and nurses on insurance details
- Prepare cost estimates for cash patients
- Adjust duties in case of sudden leaves by colleagues
- Manage and hand over pending cases to next shift
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