Submission & Resubmission Officer

About the role

The Submission & Resubmission Officer will manage the end‑to‑end processing of inpatient (IP) and outpatient (OP) claims at NMC Royal Hospital, ensuring accurate coding, timely submission, and effective resubmission of denied claims.

Key responsibilities

• Code IP and OP claims to the highest specificity using ICD‑10‑CM and CPT/HCPCS codes and verify eligibility and authorizations.
• Upload e‑claims to the DHPO or RIAYATI regulator portals and meet daily targets for claim finalisation.
• Identify root causes of denied claims, perform denial analysis and resubmit with appropriate documentation.
• Report denial trends, coordinate with payers for clarification, and support audit activities.
• Provide coding and compliance training to claims processors and clinical teams.
• Maintain confidentiality of patient, clinical and insurance information and adhere to hospital and payer policies.

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 claims submission and resubmission.

Required skills

• ICD‑10‑CM coding.
• CPT/HCPCS coding.
• Medical claims submission and e‑claims portal usage (DHPO, RIAYATI).
• Denial analysis and root‑cause identification.
• EMR documentation review.
• Coordination with clinicians and payers for coding clarification.