Submission & Resubmission Supervisor
Review and audit medical claims for accuracy, manage resubmissions, ensure compliance with billing guidelines, and adhere to Occupational Safety and Health standards.
Skills
About This 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 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 those requirements
- Work 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 assistance with the preparation of risk assessments, incident reports
- Comply with Waste management procedures and policies
- Attend applicable OSH/Infection control training programs, mock drills and awareness programs
- Use of appropriate personal protective equipment and safety systems.
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 (OSH) and Infection Control Responsibilities
- 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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