Submission & Resubmission Officer – Healthcare Claims

About the role

The Submission and Resubmission Officer ensures accurate coding, submission and resubmission of inpatient (IP) and outpatient (OP) claims at NMC Royal Hospital in Sharjah, adhering to payer policies and meeting daily processing targets.

Key responsibilities

• Code diagnoses using ICD-10-CM and procedures with CPT/HCPCS to the highest specificity and submit claims for IP and OP services.
• Verify eligibility and authorizations, capture administrative details, and upload e-claims to DHPO or RIAYATI portals.
• Achieve daily targets of 250 OP or 18 IP submissions and 150 OP or 12 IP resubmissions, adjusting as needed.
• Analyse denied claims, perform root-cause analysis, and resubmit with correct documentation and remarks.
• Report denial trends, coordinate with payers for clarifications, and support reconciliation and audits.
• Provide coding and compliance training to claims processors and clinical staff, and prepare daily submission and denial reports.
• Maintain confidentiality of patient and insurance information and ensure compliance with hospital and regulatory guidelines.

Required profile

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

Required skills

• Proficiency with ICD-10-CM, CPT and HCPCS coding.
• Experience using e-claims portals (DHPO, RIAYATI) and EMR systems.
• Denial analysis and root-cause investigation.
• Effective communication with clinicians and payers.
• Knowledge of payer policies and regulatory guidelines.