Job Description

Job Description

Oversee and coordinate end-to-end resubmission operations through claim analysis, team support, quality auditing, training, and interdepartmental communication to ensure accurate and efficient insurance reimbursement.

Responsibilities

• Preparing date-wise production log for the team. (Pharmacy /Clinic) 
• Facilities doubt clearing (Coding, insurance Queries). 
• Sharing rejection feedback to the Submission team.
•  Sharing rejection feedback to the Approval team.
•  Sharing rejection feedback to the reception/registration team.
•  Sharing doctor monthly rejection reports to accounts.
•  Sharing recon sheet to all team members.
•  Giving feedback to the resubmission team. 
• Giving Induction to New joiners. 
• Clarifying the queries to the Insurance Company.
• Auditing the resubmission files and sharing the feedback with the team. 
• Monthly team meeting with resubmission team sharing the ideas. 
• Analyzing the rejections.
•  Sharing rejection updates to medical auditor to share with respective doctors. 
• Doing Resubmission production for assigned facility.
• Supporting submission team for their queries 
• Maintain the production log in the E-claim link DHPO from team. 

• Clearing the team’s queries regarding rejections.

Qualifications

• College Diploma – Any discipline or related fields. 
• Coding Certification, CPC – Certified Professional Coder (AAPC)

Proficiency in:

• ICD-10-CM (diagnosis codes)
• CPT (procedure codes)

HCPCS Level II (supplies, equipment, services)