Submission And Resubmission Officer

NMC Healthcare; Sharjah; On-site; AED 120,000 - 180,000; Full time

Job summary

NMC Royal Hospital in Sharjah is seeking a skilled RCM Officer – Submission & Resubmission to manage claims submission and denial resolution. You will code IP/OP claims with ICD-10-CM and CPT/HCPCS, verify eligibility and authorization, and meet daily targets.

You will work with clinicians and payers, supported by the RCM Manager, to ensure timely payments. This role requires 2+ years of experience, a relevant degree, and professional certification per hospital policy; familiarity with EMR and

Qualifications

• Minimum 2 years of experience in a similar RCM role.
• Bachelor's degree in nursing, pharmacy, physiotherapy, or related fields.
• AAPC or AHIMA certification preferred / mandatory per hospital policy.
• Strong knowledge of ICD-10-CM coding and CPT/HCPCS coding.
• Experience with EMR systems and hospital billing processes.

Responsibilities

• Submit and resubmit IP/OP claims with accurate ICD/CPT coding and payer compliance.
• Review denied claims, perform root cause analysis, and resubmit with supporting docs.
• Meet daily submission targets: 250 OP/day or 18 IP/day; adjust by workload.
• Coordinate with payers to resolve denials and clarify requirements.
• Prepare denial and submission reports and support staff training.
• Maintain confidentiality and adhere to hospital policies.

Skills

ICD-10 coding

CPT/HCPCS coding

Claims submission

Denial analysis

Education

Bachelor's degree in nursing, pharmacy, physiotherapy, or related fields

AAPC or AHIMA certification (mandatory per policy)

Tools

EMR systems

Regulator portals (DHPO/RIAYATI)

Job description

Job Description:

The duties and responsibilities of the RCM Officer – Submission & Resubmission

at NMC Royal Hospital, Sharjah, are as follows:

Claims Submission:

• Ensure that claims (IP / OP) are coded to the highest specificity for Diagnosis using ICD-10 CM codes and relevant CPT/HCPCS codes and adjudicated as per Payer Policies.

• Ensure that the administrative details (Eligibility & authorization verification) are captured correctly in the bill to ensure claim payment in the initial submission.

• Meets the assigned daily target as per the RCM requirements – Finalize 250 OP per day or 18 IP per day. Targets may be revised based on workload, staffing, and management discretion.

• Upload e-claims to the regulator portal DHPO or RIAYATI for direct billing claims.

• Report variations or irrelevance in CPT codes used for services/procedures and communicate with the Clinicians for missing / correct documentation.

• Assist in providing proper CPT/HCPCS codes for newly added services/procedures.
• Claims Resubmission:

• Review the denied IP / OP claims and identify the Root cause analysis of denials Resubmit claims with appropriate documentation and remarks after reviewing the complete documentation in EMR.

• Meets the assigned daily target as per the RCM requirements – Process for resubmission 150 OP claims per day or 12 IP claims per day. Targets may be revised based on workload, staffing, and management discretion.

• Denial trend reporting to management - Identify the rejection trends and analyze and elevate for appropriate action

• Coordinate with Payers for clarification of denials and queries raised by the Payers.

• Work in coordination with the RCM Manager to support claims reconciliation, payer audits, and other assigned activities.

Training and Reporting:

• Support in Daily reporting and preparing denial and submission reports
• Support coding and compliance training and provide training materials and support to Claims processors – Submission & Resubmission and clinical team regarding ICD/CPT and other medical coding requirements.
• Provide timely feedback about rectification of the denials related to Coding, billing and approvals.

General Responsibilities

• Maintain confidentiality of patient, clinical, and insurance information.
• Adhere strictly to hospital policies, payer requirements, and regulatory guidelines.
• Accurately enter and maintain coding data in hospital billing systems.
• Be available to clinicians and internal stakeholders for ICD/CPT clarification and coding support.
• Perform any additional RCM-related tasks as assigned by the RCM Manager.

Responsibilities

The duties and responsibilities of the RCM Officer – Submission & Resubmission

at NMC Royal Hospital, Sharjah, are as follows:

Claims Submission:

• Ensure that claims (IP / OP) are coded to the highest specificity for Diagnosis using ICD-10 CM codes and relevant CPT/HCPCS codes and adjudicated as per Payer Policies.

• Ensure that the administrative details (Eligibility & authorization verification) are captured correctly in the bill to ensure claim payment in the initial submission.

• Meets the assigned daily target as per the RCM requirements – Finalize 250 OP per day or 18 IP per day. Targets may be revised based on workload, staffing, and management discretion.

• Upload e-claims to the regulator portal DHPO or RIAYATI for direct billing claims.

• Report variations or irrelevance in CPT codes used for services/procedures and communicate with the Clinicians for missing / correct documentation.

• Assist in providing proper CPT/HCPCS codes for newly added services/procedures.
• Claims Resubmission:

• Review the denied IP / OP claims and identify the Root cause analysis of denials Resubmit claims with appropriate documentation and remarks after reviewing the complete documentation in EMR.

• Meets the assigned daily target as per the RCM requirements – Process for resubmission 150 OP claims per day or 12 IP claims per day. Targets may be revised based on workload, staffing, and management discretion.

• Denial trend reporting to management - Identify the rejection trends and analyze and elevate for appropriate action

• Coordinate with Payers for clarification of denials and queries raised by the Payers.

• Work in coordination with the RCM Manager to support claims reconciliation, payer audits, and other assigned activities.

Training and Reporting:

• Support in Daily reporting and preparing denial and submission reports
• Support coding and compliance training and provide training materials and support to Claims processors – Submission & Resubmission and clinical team regarding ICD/CPT and other medical coding requirements.
• Provide timely feedback about rectification of the denials related to Coding, billing and approvals.

General Responsibilities

• Maintain confidentiality of patient, clinical, and insurance information.
• Adhere strictly to hospital policies, payer requirements, and regulatory guidelines.
• Accurately enter and maintain coding data in hospital billing systems.
• Be available to clinicians and internal stakeholders for ICD/CPT clarification and coding support.
• Perform any additional RCM-related tasks as assigned by the RCM Manager.

Qualifications

Qualification

Bachelors degree in nursing, pharmacy, physiotherapy, or related fields preferred.

AAPC or AHIMA certification preferred / mandatory as per hospital policy

Experience

Minimum 2 years of experience in a similar role

Requirements: