Submission & Resubmission Supervisor

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.
• 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.
• Bachelor’s degree in Medical or Paramedical field (Nursing, Pharmacy, or related discipline) from a recognized university.
• Minimum 2 years of experience in insurance claims management and/or adjudication.
• Prior experience in medical coding is preferred.
• Strong command of both written and spoken English.