Submission & Resubmission Officer

NMC; Sharjah; On-site; AED 78,000 - 134,000; Full time

Job summary

NMC Royal Hospital, Sharjah invites applications for an RCM Officer – Submission & Resubmission to manage medical claim submissions, resubmissions, and denial management in a fast-paced healthcare setting. The ideal candidate holds a nursing, pharmacy or related degree with AAPC/AHIMA certification if required, 2+ years in a similar role, and strong knowledge of ICD-10, CPT/HCPCS, and payer policies.

You will collaborate with clinicians and RCM leadership to ensure accurate coding, timely

Qualifications

• Bachelor's degree in nursing, pharmacy, physiotherapy, or related fields preferred.
• AAPC or AHIMA certification preferred / mandatory as per hospital policy
• Minimum 2 years of experience in a similar role

Responsibilities

• 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.
• 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.
• 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.
• 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.

Education

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

Job description

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.

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

Bachelor's 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