Submission & Resubmission Officer

• Submit claims and required documentation accurately and within established timelines.
• Review rejected or denied claims and prepare resubmissions after correcting identified issues.
• Verify claim completeness, coding, and supporting documentation before submission.
• Monitor claim status and follow up on pending, rejected, or returned claims.
• Investigate rejection and denial reasons and coordinate with relevant departments to resolve issues.
• Maintain accurate records of submissions, resubmissions, and claim outcomes.
• Ensure compliance with payer guidelines, company policies, and regulatory requirements.
• Communicate with insurance companies, third-party administrators (TPAs), and internal stakeholders regarding claim status and requirements.
• Prepare daily, weekly, and monthly reports on submission activities, rejection trends, and resubmission performance.
• Escalate complex or recurring issues to the Team Lead or Manager.
• Participate in quality improvement initiatives to reduce rejection rates and improve first-pass claim acceptance.
• Stay updated on changes in payer requirements, coding guidelines, and submission processes.

Responsibilities

• Submit claims and required documentation accurately and within established timelines.
• Review rejected or denied claims and prepare resubmissions after correcting identified issues.
• Verify claim completeness, coding, and supporting documentation before submission.
• Monitor claim status and follow up on pending, rejected, or returned claims.
• Investigate rejection and denial reasons and coordinate with relevant departments to resolve issues.
• Maintain accurate records of submissions, resubmissions, and claim outcomes.
• Ensure compliance with payer guidelines, company policies, and regulatory requirements.
• Communicate with insurance companies, third-party administrators (TPAs), and internal stakeholders regarding claim status and requirements.
• Prepare daily, weekly, and monthly reports on submission activities, rejection trends, and resubmission performance.
• Escalate complex or recurring issues to the Team Lead or Manager.
• Participate in quality improvement initiatives to reduce rejection rates and improve first-pass claim acceptance.
• Stay updated on changes in payer requirements, coding guidelines, and submission processes.

Qualifications

• Bachelor's degree or diploma in Healthcare Administration, Medical Records, Business Administration, or a related field.
• 1–3 years of experience in medical claims submission, revenue cycle management, or healthcare operations.
• Familiarity with insurance claim processing and payer requirements is preferred.