Submission & Resubmission Officer

Overview

• 2.1 Resubmission Officer will be responsible for filing and tracking insurance claims and informing patients of their claims status.
• Process insurance and disability claims in a timely manner, prepares insurance forms and associated correspondences.
• 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 the service to the respective payers.
• Ensure that the billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.
• Handling the resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
• Submit the claims with proper codes and format to insurance companies within the stipulated time.
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.
• Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply with those requirements.
• Work in accordance with the documented OSH procedures and instructions, specific responsibilities.
• Be familiar with emergency and evacuation procedures.
• Notifying OSH hazards, incidents, near misses and issues and assist with the preparation of risk assessments and incident reports.
• Comply with waste management procedures and policies.
• Attend applicable OSH/infection control training programs, mock drills and awareness programs.
• Use appropriate personal protective equipment and safety systems.
• Ensure that employees follow applicable OSH/infection control policies, procedures and standards.
• Provide OSH information, training and supervision to staff.
• Report any OSH-related incidents, near misses, and hazards in the department in a timely manner.
• Ensure that incident corrective actions have been implemented.
• Assist with preparation of risk assessments and monitoring control measures.
• Ensure trainings are conducted, including general/departmental/FMS/OSH orientation for new employees and transferred employees, refresher training for department staff, etc.
• Medical/paramedical (nursing, pharmacy, etc.) graduate from a recognized university.
• Experience in insurance claims management/adjudication (minimum 2 years).
• Experience in medical coding is preferable.
• Excellent command of oral and written English.