Submission & Resubmission Team Lead

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Review and Audit Medical Claims to ensure their accuracy.

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Resubmission of rejected claims.

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Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.

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Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.

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Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.

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Submit the claims with proper codes and format to insurance companies within the stipulated time.

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Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

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Comply with all OSH and infection control policies, standards and procedures and cooperate with hospital management to comply those requirements.

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Work accordance with the documented OSH procedures and instructions, specific responsibilities.

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Be familiar with emergency and evacuation procedures.

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Notifying OSH Hazards, incidents, Near misses and issues and assistance with the preparation of risk assessments, incident reports.

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Comply with Waste management procedures and policies.

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Attend applicable OSH/Infection control training programs, mock drills and awareness programs.

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Use of appropriate personal protective equipment and safety systems.

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Review and audit medical claims to ensure accuracy.

-

Resubmission of rejected claims.

-

Ensure that the agreed price list and provider manual from insurance companies are followed when billing services to the respective payers.

-

Ensure that Billing Officers are updated on rejections in a timely manner and corrective actions are taken to avoid similar instances in the future.

-

Handle the resubmission of rejected claims, follow up with respective doctors for claim justification, if necessary, and prepare claims for resubmission.

-

Submit claims with proper codes and formats to insurance companies within the stipulated time.

-

Perform any other jobs or duties assigned by the HOD from time to time within the scope of the job title.

-

Comply with all OSH and infection control policies, standards and procedures, and cooperate with hospital management to meet these requirements.

-

Work in accordance with documented OSH procedures, instructions and specific responsibilities.

-

Be familiar with emergency and evacuation procedures.

-

Notify OSH of 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 programmes, mock drills and awareness programmes.

-

Use appropriate personal protective equipment and safety systems.

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Medical/Paramedical graduate (Nursing, Pharmacy, etc.) from a recognized university.

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Minimum 2 years of experience in Insurance Claims Management/Adjudication.

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Experience in Medical Coding is preferable.

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Excellent command of oral and written English.