Submission & Resubmission Officer

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.

Responsibilities

Managerial

• Coordinate with relevant teams to ensure smooth insurance claims processing and workflow efficiency

• Support communication between billing, coding, and insurance departments

Technical

• 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