Resubmission Officer

Handles resubmission of denied claims, coordinates responses to queries, and reviews rejections from payers, assigning codes accordingly. Compiles reconciliation sheets, conducts denial analysis, provides feedback, and oversees the training of new joiners. Monitors denial trends, reporting findings to the Supervisor and ensuring feedback to the concerned unit.

• Handles resubmission of denied claims, adhering to work allocation and denial analysis, and providing timely feedback.
• Coordinates with both internal and external stakeholders to ensure prompt responses to emails and queries regarding resubmissions.
• Conducts review of rejections from payers, assigning appropriate codes based on physician responses to post-rejection queries.
• Compiles quarterly or semi-annual reconciliation sheets and engages in follow-up communication with payers.
• Performs denial analysis and provides feedback to all relevant stakeholders involved.
• Trains and guides new joiners in the resubmission process.
• Monitors denial trends, report findings to the Supervisor and ensures feedback is provided to the concerned unit.

• Bachelor’s Degree in any field, Medical preferred

PROFESSIONAL EXPERIENCE:

• Minimum of zero (0) to two (2) years of experience in the Insurance Department.
• Knowledge of Claims Resubmission, Spreadsheets, and Software Modules.
• Skills in Current Procedural Terminology (CPT) Coding.
• Skills in utilizing Health Information Systems (HIS) software.
• Ability to speak and write in English fluently.