Submission & Resubmission Supervisor

• Review and audit medical claims to ensure accuracy, completeness, and compliance with payer requirements.

• Manage the resubmission of rejected claims, ensuring all necessary corrections and supporting documentation are provided.

• Ensure adherence to agreed pricing lists, provider manuals, and insurance company guidelines when billing services to respective payers.

• Communicate claim rejections to Billing Officers in a timely manner and implement corrective actions to minimize future occurrences.

• Coordinate with physicians and other stakeholders to obtain clinical justifications and supporting documentation for claim resubmissions when required.

• Submit claims using appropriate coding standards and formats within the stipulated timelines established by insurance companies.

• Maintain compliance with regulatory requirements, payer policies, and organizational standards related to medical claims processing.

• Perform any other duties assigned by the Head of Department (HOD) within the scope of the role.

Occupational Safety & Health (OSH) and Infection Control Responsibilities

• Comply with all Occupational Safety & Health (OSH) and Infection Control policies, procedures, standards, and guidelines.

• Perform duties in accordance with documented OSH procedures, work instructions, and assigned responsibilities.

• Be familiar with emergency response and evacuation procedures.

• Report OSH hazards, incidents, near misses, and safety concerns promptly, and assist in the preparation of risk assessments and incident reports.

• Adhere to waste management policies and procedures.

• Attend mandatory OSH and Infection Control training programs, mock drills, and awareness sessions.

• Utilize appropriate personal protective equipment (PPE) and safety systems as required.

• Cooperate with hospital management to support and maintain a safe and healthy working environment.

• Bachelor’s degree in Medical or Paramedical field (Nursing, Pharmacy, or related discipline) from a recognized university.

• Minimum 2 years of experience in insurance claims management and/or adjudication.

• Prior experience in medical coding is preferred.

• Strong command of both written and spoken English.