Submission & Resubmission Supervisor
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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 adhere to Occupational Safety and Health standards.
Key Skills for This Role
Responsibilities
- Review and audit medical claims to ensure accuracy, completeness, and compliance with payer requirements
- Manage the resubmission of rejected claims, ensuring all necessary corrections and supporting documentation are provided
- Ensure adherence to agreed pricing lists, provider manuals, and insurance company guidelines when billing services
- Communicate claim rejections to Billing Officers in a timely manner and implement corrective actions
- Coordinate with physicians and other stakeholders to obtain clinical justifications for claim resubmissions
- Submit claims using appropriate coding standards and formats within stipulated timelines
- Maintain compliance with regulatory requirements, payer policies, and organizational standards
- Perform any other duties assigned by the Head of Department within the scope of the role
Requirements
- Review and audit medical claims to ensure accuracy, completeness, and compliance with payer requirements
- Manage resubmission of rejected claims with necessary corrections and supporting documentation
- Ensure adherence to agreed pricing lists, provider manuals, and insurance company guidelines
Full Job Posting
Role 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 for billing.
Key Responsibilities
- Review and audit medical claims to ensure accuracy, completeness, and compliance with payer requirements.
- Manage the resubmission of rejected claims, ensuring all necessary corrections and supporting documentation are provided.
- Ensure adherence to agreed pricing lists, provider manuals, and insurance company guidelines when billing services to respective payers.
- Communicate claim rejections to Billing Officers in a timely manner and implement corrective actions to minimize future occurrences.
- Coordinate with physicians and other stakeholders to obtain clinical justifications and supporting documentation for claim resubmissions when required.
- Submit claims using appropriate coding standards and formats within the stipulated timelines established by insurance companies.
- Maintain compliance with regulatory requirements, payer policies, and organizational standards related to medical claims processing.
- Perform any other duties assigned by the Head of Department (HOD) within the scope of the role.
Occupational Safety & Health and Infection Control
- Comply with all Occupational Safety & Health (OSH) and Infection Control policies, procedures, standards, and guidelines.
- Perform duties in accordance with documented OSH procedures, work instructions, and assigned responsibilities.
- Be familiar with emergency response and evacuation procedures.
- Report OSH hazards, incidents, near misses, and safety concerns promptly, and assist in the preparation of risk assessments and incident reports.
- Adhere to waste management policies and procedures.
- Attend mandatory OSH and Infection Control training programs, mock drills, and awareness sessions.
- Utilize appropriate personal protective equipment (PPE) and safety systems as required.
- Cooperate with hospital management to support and maintain a safe and healthy working environment.
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