Submission & Resubmission Officer

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