Submission & Resubmission Officer

About the role

The Submission & Resubmission Officer is responsible for ensuring that medical claims are submitted accurately and on time, while managing any rejections or denials to support the hospital’s revenue cycle. This role works closely with internal departments and external payers to maintain compliance and improve first‑pass claim acceptance.

Key responsibilities

• Submit claims and required documentation within established timelines.
• Review rejected or denied claims, correct issues, and prepare resubmissions.
• Verify claim completeness, coding, and supporting documentation before submission.
• Monitor claim status and follow up on pending, rejected, or returned claims.
• Investigate reasons for rejections and coordinate with relevant departments to resolve them.
• Maintain accurate records of submissions, resubmissions, and outcomes.
• Ensure compliance with payer guidelines, company policies, and regulatory requirements.
• Communicate with insurance companies, third‑party administrators, and internal stakeholders regarding claim status.
• Prepare daily, weekly, and monthly reports on submission activities and rejection trends.
• Escalate complex or recurring issues to the Team Lead or Manager.
• Participate in quality improvement initiatives to reduce rejection rates.
• Stay updated on changes in payer requirements, coding guidelines, and submission processes.

Required profile

• Bachelor’s degree or diploma in Healthcare Administration, Medical Records, Business Administration, or a related field.
• 1–3 years of experience in medical claims submission, revenue cycle management, or healthcare operations.
• Familiarity with insurance claim processing and payer requirements is preferred.

Required skills

• Medical coding knowledge.
• Understanding of insurance claim processing and payer guidelines.