Submission And Resubmission Team 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

Job Description:

1. Review and audit medical claims to ensure accuracy.
   
   
   
   1. Resubmission of rejected claims.
   
   
   2. Ensure that the agreed price list and provider manual from insurance companies are followed for billing the service to the respective payers.
   
   
   3. Ensure that the Billing officers are updated on time with the rejections and corrective action is taken to avoid such instances in future.
   
   
   4. Handling the Resubmission of rejected claims, follow up with respective doctors for justifying the claims if necessary and prepare them for resubmission.
   
   
   5. Submit the claims with proper codes and format to insurance companies within the stipulated time.
   
   
   
   


2. Perform any other jobs or duties assigned by the HOD from time to time within the scope of the job title.
   
   
   
   1. Comply with all OSH and infection control policies, standards and procedures, and cooperate with hospital management to meet these requirements.
   
   
   2. Work in accordance with documented OSH procedures, instructions and specific responsibilities.
   
   
   3. Be familiar with emergency and evacuation procedures.
   
   
   4. Notify OSH of hazards, incidents, near misses and issues, and assist with the preparation of risk assessments and incident reports.
   
   
   5. Comply with waste management procedures and policies.
   
   
   6. Attend applicable OSH/infection control training programmes, mock drills and awareness programmes.
   
   
   7. Use appropriate personal protective equipment and safety systems.
   
   
   
   

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.


• 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.

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.

Requirements: