Submission & Resubmission Officer
Review and audit medical claims for accuracy, manage resubmissions, ensure compliance with billing guidelines, and submit claims timely with proper coding.
Skills
About This Role
Overview
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.
Responsibilities
- Review and audit medical claims to ensure accuracy.
- Manage resubmission of rejected claims.
- Ensure adherence to agreed price lists and insurance provider manuals for accurate billing to respective payers.
- Update billing officers promptly on claim rejections and ensure corrective actions are implemented to prevent recurrence.
- Handle resubmission of rejected claims, including follow-up with doctors for justification where necessary and preparation of claims for resubmission.
- Submit claims with proper coding and formatting to insurance companies within stipulated timelines.
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