Resubmission Officer

Full job description

. The Claims Submission & Resubmission Officer is responsible for preparing, submitting, and monitoring medical claims to insurance companies to ensure accurate and timely reimbursement for hospital services.

Supervise the day-to-day operations related to the submission of insurance claims, ensuring adherence to payer guidelines and industry standards.

Collaborate with coding and billing teams to verify that all claims are complete, accurate, and compliant prior to submission.

Monitor and manage submission workflows to minimize delays and errors.

Oversee the resubmission process for denied or rejected claims, ensuring prompt and effective resolution.

Analyze denial trends to identify root causes and develop corrective action plans for improved first-pass acceptance rates.

Liaise with payers to clarify rejection issues and ensure proper documentation is submitted during resubmissions.

Develop and implement standard operating procedures to streamline both submission and resubmission processes.

Ensure all activities adhere to regulatory requirements, internal policies, and payer-specific guidelines.

Conduct periodic audits and quality checks to validate the accuracy and compliance of claims processing.

Provide mentorship and support to team members involved in submission and resubmission activities.

Assist in conducting performance evaluations and organizing training sessions to enhance staff competency and knowledge.

Serve as an escalation point for complex issues or disputes related to claim submissions.

Track KPIs such as submission accuracy, denial rates, and resubmission turnaround times.

Prepare regular reports for senior management, highlighting trends, challenges, and areas for improvement.

Use data insights to recommend and implement process enhancements that improve overall revenue cycle performance.

Bachelor’s degree in Healthcare Administration, Business, or a related field.

Experience in revenue cycle management, with a focus on claims submission and resubmission processes.

Prior experience in a supervisory or leadership role is preferred.

In-depth knowledge of medical billing, coding standards (ICD-10, CPT, HCPCS), and payer guidelines.

Strong analytical skills and proficiency in data-driven decision-making.

Excellent communication, problem-solving, and conflict resolution skills.

Ability to manage multiple priorities, work under pressure, and drive continuous process improvement initiatives.

 

Industries:Health, Wellness & Fitness

Function: Healthcare Administration