Submission & Resubmission Officer

Job description

3.1 Review and Audit 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.

• Medical/Nursing graduate from a recognized university.

• Experience in insurance claims resubmission.

• Experience in medical coding is preferred.

• Excellent command of written and spoken English.

• Review and audit medical claims to ensure accuracy and compliance.

• Handle the resubmission of rejected claims.

• Ensure that agreed price lists and provider manuals from insurance companies are followed when billing services to respective payers.

• Ensure billing officers are updated promptly on claim rejections and corrective actions are taken to prevent recurrence.

• Follow up with the respective doctors to obtain justifications for rejected claims, where necessary, and prepare claims for resubmission.

• Submit claims to insurance companies with the correct codes and format within the stipulated timelines.