Medical Claims Resubmission Lead

NMC Healthcare; Abu Dhabi; On-site; AED 60,000 - 90,000; Full time

Job summary

NMC Healthcare in the United Arab Emirates is seeking a Billing Claims professional to review and audit medical claims, resubmit rejected claims, and ensure compliance with insurer price lists and provider manuals. You will coordinate with Billing Officers to address rejections and prepare claims for resubmission.

The role requires processing claims with correct codes, adhering to timelines, and coordinating with doctors for justifications when needed, while following OSH and infection control

Qualifications

• Medical/Paramedical graduate (Nursing, Pharmacy, etc.) from a recognized university.
• Minimum 2 years of experience in Insurance Claims Management/Adjudication.
• Experience in Medical Coding is preferable.
• Excellent command of oral and written English.

Responsibilities

• 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.

Skills

English language

Education

Medical/Paramedical graduate

Job description

NMC Healthcare in the United Arab Emirates is seeking a Billing Claims professional to review and audit medical claims, resubmit rejected claims, and ensure compliance with insurer price lists and provider manuals. You will coordinate with Billing Officers to address rejections and prepare claims for resubmission.

The role requires processing claims with correct codes, adhering to timelines, and coordinating with doctors for justifications when needed, while following OSH and infection control