Senior Resubmission Officer

About the role

The Senior Resubmission Officer ensures that denied, rejected, or under‑paid insurance claims are accurately corrected and resubmitted in a timely manner, maximizing reimbursement for healthcare services provided by the pharmacy group.

Key responsibilities

• Analyse claim rejections and identify root causes.
• Clarify rejection queries with insurance companies.
• Perform resubmission production for assigned facilities while maintaining quality standards.
• Communicate rejection feedback to the Submission, Approval, and Reception teams.
• Assist facilities with coding and insurance queries.
• Participate in monthly team meetings to discuss rejection trends and ideas.
• Provide updates to medical auditors and support the submission team with queries.
• Prepare justification documents for reconciliation claims.

Required profile

• College diploma in any discipline or related field.
• Coding certification such as CPC – Certified Professional Coder (AAPC) is preferred.
• Experience handling insurance claim rejections and resubmissions in a healthcare setting.

Required skills

• Proficiency with ICD‑10‑CM diagnosis coding.
• Proficiency with CPT procedure coding.
• Proficiency with HCPCS Level II coding for supplies, equipment, and services.