Submission & Resubmission Team Lead

About the role

Speciality Hospital Abu Dhabi is looking for a Submission & Resubmission Team Lead to oversee the review and audit of medical claims, their resubmission after rejection, and compliance with payer price lists and provider manuals. The role also involves keeping billing officers informed and following OSH and infection control procedures.

Key responsibilities

• Review and audit medical claims to ensure their accuracy.
• Handle the resubmission of rejected claims, including following up with doctors to justify claims where needed and preparing them for resubmission.
• Ensure the agreed price list and provider manual from insurance companies are followed when billing services to payers.
• Keep Billing Officers updated on rejections in a timely manner and help take corrective action to prevent recurrence.
• Submit claims with the correct codes and formats to insurance companies within the stipulated time.
• Perform other duties assigned by the Head of Department within the scope of the job title.
• Comply with OSH and infection control policies, including emergency and evacuation procedures, waste management, and reporting hazards, incidents and near misses.
• Attend OSH and infection control training, mock drills and awareness programmes, and use appropriate personal protective equipment.

Required profile

• Medical or paramedical graduate (e.g. Nursing, Pharmacy) from a recognised university.
• Minimum 2 years of experience in insurance claims management/adjudication.
• Excellent command of oral and written English.