Resubmission Officer IP Coding

To audit & process all type of rejected claims received by the payers and resubmitting them correctly after thorough investigation and justification.

Primary Responsibilities:

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Properly process and audit all type of claims received by the payers, from the medical and insurance perspective.

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Assure meeting the daily assigned target in terms of quantity & quality.

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Report back any type of claims observation or issues that may affect the process.

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Ensure that the medical ethics are respected at all times while performing the medical evaluation of the claims.

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Participate in developing the rules engine and the billing system by providing new ideas or proposal in order to enhance the process.

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Contribute in developing, updating and implementing the guidelines for evaluation and processing of medical claims, as well as policies and procedures and work instructions related to medical claims review and processing.

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Gather relevant information to clearly describe and properly escalate issues to supervisors and managers.

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Ensure high quality customer service and respect medical and work ethics at all times while conducting daily tasks.

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Ensure that business decisions and processes are documented in a professional way and the communication requirements are being adhered to in a timely and professional manner.