Submission Officer

Job Description

Responsible for managing the claims process and related issues.

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

Documenting

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 :-

Special Certificate:-

Required

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

Desired

Experience in a large healthcare facility