Submission & Resubmission Officer
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Key skills for this role
About the Role
Responsible for preparing and submitting medical claims, ensuring accuracy, compliance, and effective communication with teams while maintaining quality standards.
Key Skills for This Role
Responsibilities
- Prepare and submit insurance claims for hospital services, ensuring accuracy in coding and patient information
- Verify patient insurance eligibility and coverage prior to claim submission
- Collaborate with billing and coding teams to ensure claims meet payer requirements
- Monitor claim submission status and follow up on pending or unprocessed claims
- Respond to insurance provider queries related to claim details
- Maintain accurate records of submitted claims and their status updates
- Stay updated with insurance policies, regulations, and claim submission protocols
Requirements
- Knowledge of insurance policies, regulations, and claim submission protocols
- Ability to verify patient insurance eligibility and coverage
- Experience in medical claims processing
Full Job Posting
Job Summary
- The Claims Submission & Resubmission Officer is responsible for preparing, submitting, and monitoring medical claims to insurance companies to ensure accurate and timely reimbursement for hospital services.
Managerial Responsibilities
- Coordinate with relevant teams to ensure smooth insurance claims processing and workflow efficiency
- Support communication between billing, coding, and insurance departments
Technical Responsibilities
- Prepare and submit insurance claims for hospital services, ensuring accuracy in coding and patient information
- Verify patient insurance eligibility and coverage prior to claim submission
- Collaborate with billing and coding teams to ensure claims meet payer requirements
- Monitor claim submission status and follow up on pending or unprocessed claims
- Respond to insurance provider queries related to claim details
- Maintain accurate records of submitted claims and their status updates
- Stay updated with insurance policies, regulations, and claim submission protocols
Quality and Safety
- Promote and maintain quality standards and support continuous quality improvement initiatives
- Comply with safety, infection control, and quality control policies and procedures
- Ensure adherence to environmental safety and infection prevention practices
- Support clinical audit processes and reporting requirements
- Communicate professionally with patients, families, and healthcare staff to obtain or clarify required information
- Ensure documentation accuracy and compliance with hospital standards
Continuous Education
- Participate in training sessions for staff, doctors, and nurses on equipment handling and related processes
- Attend departmental programs, hospital committees, and staff meetings when required
- Support orientation and training of new employees
- Maintain professional knowledge through lectures, seminars, and online learning
- Complete all required licensing, certification, and mandatory training within deadlines
- Apply knowledge of relevant sciences such as anatomy, physiology, and related technical fields
Occupational Safety and Health (OSH)
- Comply with all OSH and infection control policies, standards, and procedures
- Report OSH hazards, incidents, near misses, and assist in risk assessments
- Participate in OSH and infection control training, drills, and awareness programs
- Follow safe working procedures and use appropriate personal protective equipment (PPE)
- Adhere to emergency and evacuation procedures
- Ensure proper waste management practices (reduce, reuse, recycle)
- Participate in OSH audits and inspections to maintain standards
Prevention and Control of Infection (PCI)
- Adhere to NMC PCI Policy and Strategy at all times
- Maintain strict hand hygiene practices, including the 5 moments of hand hygiene
- Follow 'bare below the elbows' and environmental cleanliness standards
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