Submission & Resubmission Officer

OverviewThe Claims Submission & Resubmission Officer is responsible for preparing, submitting, and monitoring medical claims to insurance companies to ensure accurate and timely reimbursement for hospital services.ResponsibilitiesPrepare and submit insurance claims for hospital services rendered, ensuring accuracy in coding and patient information.Verify patient insurance coverage and eligibility prior to claim submission.Collaborate with billing and coding teams to ensure claims meet payer requirements.Monitor claim submission status and follow up on unprocessed or pending claims.Respond to queries from insurance providers regarding claim details.Maintain detailed records of all submitted claims and their statuses.Stay updated with changes in insurance policies and claim submission protocols.Promote and maintain quality in all services and ensure continuous quality improvement measures are in place.Conduct method evaluation and development as per standard policies and procedures.Comply with all safety and quality control programs and procedures as applicable.Apply precautions for environmental safety, infection control, and minimize cross‑infections.Ensure that safety procedures and quality assurance tests are maintained within all sections.Comply and support clinical audit processes within the service and report as agreed.Communicate professionally with patients, families and other medical personnel to obtain information for laboratory records, clarify orders and communicate status.Participate in education sessions for department staff, doctors and nurses on safe equipment handling, induction, peer review, case studies and clinical presentations.Participate in department programs, committees and staff meetings when requested.Participate in orientation and training of new employees.Maintain professional knowledge by attending lectures, seminars or online education sessions.Complete and maintain all regulatory requirements including licensure and certification and other mandatory training within established time frames.Apply technical skills and demonstrate knowledge of sciences such as anatomy, physiology and physics.Comply with OSH and infection control policies, standards and procedures and cooperate with hospital management.Notify OSH hazards, incidents, near‑misses and assist with risk assessments, incident reports.Attend applicable OSH/infection‑control training, mock drills and awareness programmes.Comply with reasonable OSH instructions, policies and safe working procedures.Use appropriate personal protective equipment and safety systems.Be familiar with emergency and evacuation procedures.Do not willfully or recklessly endanger health and safety of others.Comply with waste management procedures and policies; reduce, reuse and recycle waste where possible.Attend all OSH trainings, awareness programmes and mock drills.Participate in OSHMS audits, inspections and ensure standards are maintained.Read and implement the NMC PCI Policy and Strategy to maintain cleanliness standards.Practice strict hand hygiene, five moments of hand hygiene, bare below the elbows and environmental care.QualificationsBachelor’s degree in healthcare administration, nursing, para‑medical or a related field.Knowledge of medical coding, billing processes and insurance claim management.Proficiency in hospital management systems and claims submission software.Strong organisational skills and attention to detail.Excellent communication and problem‑solving abilities.Self‑motivation and the ability to work under pressure.Fluent spoken and written English; spoken Arabic advantageous but not essential.A supportive and caring disposition.Adaptability and good time‑management skills.Confidence in dealing with stressful situations.IT competencies.Experience & CertificationsExperience required in addition to the Qualifications mentioned above.Specialist Certification – Required: NA; Desired: NA.Remarks#J-18808-Ljbffr