Job Description

Submission Officer-ACH-Patient Finance Services

Job Description

The Submission Officer is responsible for managing and monitoring healthcare insurance claims and billing processes to ensure compliance with insurance policies, contractual agreements, and facility pricing guidelines. The position involves validating and processing inpatient and outpatient claims, resolving rejected or unpaid claims, preparing financial documentation and statements, and ensuring accurate insurance-related records. This Officer also provides financial support to patients and clinics, addresses inquiries, identifies and resolves billing issues, and contributes to process improvement initiatives while collaborating with internal teams to enhance operational efficiency and compliance.

Responsibilities

•  Monitoring compliance to insurance company’s terms and conditions    Monitoring compliance the rules and the contractual terms and agreement with the insurance companies
• Ensuring compliance by the facility pricing structure and the rules for the different patient categories (including self-payer) with implementation
• Assisting in collecting and processing claims
• Validating the claimed outpatient services (Laboratory, Radiology and Pharmaceuticals)
• Checking the claim invoices (inpatient and outpatient)
• Generating and regenerate the missed and incorrect invoices
• Processing each claim in the system
• Attending answering about financial matters, to patient and Specialty clinics inquiries
• Preparing statement of accounts
• Following –up the claims submission to the insurance company
• Ensuring that all insurance documents been properly filled and claiming related amount
• Comparing the cancelled receipts received from cashiers on monthly basis to ensure that there are no manipulations in canceling transaction
• Resubmitting the rejected claims with a wrong reason or without reason and unpaid claims
• Providing customer service and support    Responding to verbal and written financial inquiries in a timely manner
• Providing technical expertise in identifying potential financial/Accounting issues
• Discussing with Manager/Senior Officer, if necessary, before recommending solutions after obtaining and verifying information
  Contributing to team effort    Participating in cross-functional teams and committees as appropriate
• Serving as a subject matter expert in regards to inventory accounts, payments and accounting systems
• Developing and enhancing team procedure manual and processes and discussed with Manager/Senior Officer

Qualifications

Qualification: Bachelor’s Degree or Diploma in any related field (medical/health science)

Special Certificate: AAPC or AHIMA Certification

Required: 2-4 years of relevant progressive experience in a similar role 

Desired: Experience in a large healthcare facility