Submission & Resubmission Officer

OSH ROLES & RESPONSIBILITIES:

GENERAL

Additional duties/responsibilities (related to ADHICS) assigned to this position in clear, concise language:

Health Information Literacy and Skills:

BCP ROLES & RESPONSIBILITIES:

DUTIES AND RESPONSIBILITIES:

• Review and Audit Medical Claims to ensure their accuracy.

• Resubmission of rejected claims.

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

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

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

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

• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title.

OSH ROLES & RESPONSIBILITIES

GENERAL

• Comply with reasonable OSH instructions, policies and safe working procedures.

• Use of appropriate personal protective equipment and safety systems.

• Be familiar with emergency and evacuation procedures.

• Not willfully or recklessly endanger anyone’s health and safety.

• Assist with the preparation of risk assessments.

• Report OSH Hazards, incidents, Near misses and issues.

• Reduce, Reuse, Recycling of waste as much as possible.

• Attend all OSH Trainings, awareness programs and mock drills.

• Participates in the OSHMS audits, inspections, ensuring standards are maintained.

Additional duties/responsibilities (related to ADHICS) assigned to this position:

Health Information Literacy and Skills

• Adhere to information systems policies and procedures as required by Health Care Organization.

Privacy, Confidentiality of Health Information

• Follow security and privacy policies and procedures to the use of networks, including intranet and Internet.

• Follow confidentiality and security measures to protect electronic health information.

• Maintain data integrity and validity within an information system.

• Report any possible breaches of confidentiality in accordance with organizational policies.

Health Information/Data Technical Security

• Apply departmental and organizational data and information system security policies.

Basic Computer Literacy Skills

• Use basic word processing, spreadsheet and desktop presentation applications as applicable to your work.

• Demonstrate proficiency in Windows operating environment.

• Demonstrate use of email, addressing, forwarding, attachments, netiquette.

BCP ROLES & RESPONSIBILITIES

• Achieving an adequate level of general awareness regarding business continuity.

• Being aware of the contents of their service areas disaster recovery plan and any specific role or responsibilities allocated.

• Participating actively in the business continuity programme when required.

• Ensuring information governance standards continue to be applied to data and information during an incident.

• Qualification: Medical/paramedical (Nursing, Pharmacy, etc.) graduate from a recognized university.

• Experience: Experience in Insurance Claims management/adjudication (minimum 2 years).

• Preferred Skill: Experience in Medical Coding is preferable.

• Language: Excellent command of oral and written English.