Submission & Resubmission Officer – Healthcare Claims

About the role

The Submission & Resubmission Officer is responsible for managing the end‑to‑end lifecycle of inpatient and outpatient claims at Royal Hospital Sharjah. The role ensures accurate coding, timely submission, and effective resolution of denied claims to optimise revenue cycle performance.

Key responsibilities

• Code IP/OP claims using ICD‑10‑CM and CPT/HCPCS with highest specificity and verify eligibility and authorisations before submission.
• Upload electronic claims to the DHPO and RIAYATI regulator portals and meet daily targets of 250 OP or 18 IP submissions.
• Identify and report CPT code inconsistencies, liaise with clinicians for correct documentation, and support coding for new services.
• Review denied claims, perform root‑cause analysis, resubmit with appropriate documentation, and achieve daily resubmission targets of 150 OP or 12 IP claims.
• Generate denial trend reports, coordinate with payers for clarifications, and assist the RCM Manager with reconciliation and audits.
• Provide daily reporting, support coding and compliance training, and deliver feedback on coding, billing and approval issues.

Required profile

• Bachelor’s degree in nursing, pharmacy, physiotherapy or a related field (preferred).
• AAPC or AHIMA certification preferred or mandatory as per hospital policy.
• Minimum of 2 years experience in a similar revenue‑cycle or medical‑coding role.

Required skills

• Proficiency in ICD‑10‑CM and CPT/HCPCS coding.
• Experience with Electronic Medical Records (EMR) for claim documentation.
• Ability to submit e‑claims via DHPO and RIAYATI portals.
• Knowledge of claim reconciliation and denial analysis.