Submission And Resubmission Officer

NMC Healthcare; Abu Dhabi; On-site; AED 78,000 - 134,000; Full time

Job summary

NMC Healthcare in Abu Dhabi is seeking an experienced Claims Submissions Specialist to manage the end-to-end claim lifecycle. You will ensure timely submission, verify documentation, and address denials with corrective resubmissions, coordinating with TPAs and internal teams.

The role requires 1–3 years in medical claims submission or revenue cycle management, with a strong eye for detail and adherence to payer guidelines.

Qualifications

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

Responsibilities

• Submit claims and required documentation accurately within established timelines.
• Review rejected or denied claims and prepare resubmissions after corrections.
• Verify claim completeness and supporting documentation before submission.
• Monitor claim status and follow up on pending, rejected, or returned claims.
• Prepare periodic reports on submission activities and rejection trends.

Skills

Attention to detail

Communication skills

Education

Bachelor's or diploma in Healthcare Administration / Medical Records / Business Administration

Job description

Job Description:

• 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

• Bachelors 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.