Submission & Resubmission Officer

NMC Healthcare; Abu Dhabi; On-site; AED 60,000 - 120,000; Full time

Job summary

NMC Specialty Hospital Abu Dhabi is seeking a Billing/Claims Auditor to review and audit medical claims and manage resubmission of rejected claims. The role requires adherence to payer rules, accurate coding, and timely submission, with strong English communication skills.

Ideal candidates hold a medical or nursing degree, experience with medical coding and insurance claims resubmission, and are proficient with billing software to ensure compliant billing to payers.

Qualifications

• Medical or Nursing graduate from a recognized university.
• Experience in insurance claims resubmission.
• Medical coding experience is preferred.
• Excellent command of spoken and written English.

Responsibilities

• Review and audit medical claims to ensure accuracy and completeness.
• Manage the resubmission of rejected claims in line with payer requirements.
• Ensure adherence to agreed price lists and provider manuals for accurate billing.
• Update billing officers promptly on claim rejections with corrective actions.
• Coordinate resubmission of rejected claims and gather physician justification when needed.
• Submit claims with accurate coding and proper formatting within timelines.

Skills

Medical claims auditing

Insurance billing

Medical coding

English proficiency

Education

Medical or Nursing graduate

Tools

Billing software

Job description

3.1 Review and A udit Medical Claims to ensure their accuracy.

3.2 Resubmission of rejected claims.

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

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

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

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

Responsibilities

• Review and audit medical claims to ensure accuracy and completeness.
• Manage the resubmission of rejected claims in line with payer requirements.
• Ensure adherence to agreed price lists and insurance provider manuals for accurate billing to respective payers.
• Update billing officers promptly on claim rejections and ensure corrective actions are implemented to prevent recurrence.
• Coordinate resubmission of rejected claims, including follow-up with physicians for justification where required, and prepare claims for resubmission.
• Submit claims with accurate coding and proper formatting to insurance companies within stipulated timelines.

Qualifications

• Medical or Nursing graduate from a recognized university.
• Experience in insurance claims resubmission.
• Medical coding experience is preferred.
• Excellent command of spoken and written English.

Job Info

• Job Identification 11471
• Job Category Administration
• Job Schedule Full time
• Locations NMC Specialty Hospital, Abu Dhabi, AE