Submission & Resubmission Officer

The duties and responsibilities of the RCM Officer – Submission & Resubmission at NMC Royal Hospital, Sharjah, are as follows: Claims Submission: Ensure that claims (IP / OP) are coded to the highest specificity for Diagnosis using ICD-10 CM codes and relevant CPT/HCPCS codes and adjudicated as per Payer Policies. Ensure that the administrative details (Eligibility & authorization verification) are captured correctly in the bill to ensure claim payment in the initial submission. Meets the assigned daily target as per the RCM requirements – Finalize 250 OP per day or 18 IP per day. Targets may be revised based on workload, staffing, and management discretion. Upload e-claims to the regulator portal DHPO or RIAYATI for direct billing claims. Report variations or irrelevance in CPT codes used for services/procedures and communicate with the Clinicians for missing / correct documentation. Assist in providing proper CPT/HCPCS codes for newly added services/procedures. Claims Resubmission: Review the denied IP / OP claims and identify the Root cause analysis of denials Resubmit claims with appropriate documentation and remarks after reviewing the complete documentation in EMR. Meets the assigned daily target as per the RCM requirements – Process for resubmission 150 OP claims per day or 12 IP claims per day. Targets may be revised based on workload, staffing, and management discretion. Denial trend reporting to management - Identify the rejection trends and analyze and escalate for appropriate action Coordinate with Payers for clarification of denials and queries raised by the Payers. Work in coordination with the RCM Manager to support claims reconciliation, payer audits, and other assigned activities. Training and Reporting: Support in Daily reporting and preparing denial and submission reports Support coding and compliance training and provide training materials and support to Claims processors – Submission & Resubmission and clinical team regarding ICD/CPT and other medical coding requirements. Provide timely feedback about rectification of the denials related to Coding, billing and approvals. General Responsibilities Maintain confidentiality of patient, clinical, and insurance information. Adhere strictly to hospital policies, payer requirements, and regulatory guidelines. Accurately enter and maintain coding data in hospital billing systems. Be available to clinicians and internal stakeholders for ICD/CPT clarification and coding support. Perform any additional RCM-related tasks as assigned by the RCM Manager.

Qualification  Bachelor's degree in nursing, pharmacy, physiotherapy, or related fields preferred.  AAPC or AHIMA certification preferred / mandatory as per hospital policy    Experience    Minimum 2 years of experience in a similar role

The duties and responsibilities of the RCM Officer – Submission & Resubmission at NMC Royal Hospital, Sharjah, are as follows:   Claims Submission:   Ensure that claims (IP / OP) are coded to the highest specificity for Diagnosis using ICD-10 CM codes and relevant CPT/HCPCS codes and adjudicated as per Payer Policies.   Ensure that the administrative details (Eligibility & authorization verification) are captured correctly in the bill to ensure claim payment in the initial submission.   Meets the assigned daily target as per the RCM requirements – Finalize 250 OP per day or 18 IP per day. Targets may be revised based on workload, staffing, and management discretion.   Upload e-claims to the regulator portal DHPO or RIAYATI for direct billing claims.   Report variations or irrelevance in CPT codes used for services/procedures and communicate with the Clinicians for missing / correct documentation.   Assist in providing proper CPT/HCPCS codes for newly added services/procedures. Claims Resubmission:   Review the denied IP / OP claims and identify the Root cause analysis of denials Resubmit claims with appropriate documentation and remarks after reviewing the complete documentation in EMR.   Meets the assigned daily target as per the RCM requirements – Process for resubmission 150 OP claims per day or 12 IP claims per day. Targets may be revised based on workload, staffing, and management discretion.   Denial trend reporting to management - Identify the rejection trends and analyze and escalate for appropriate action   Coordinate with Payers for clarification of denials and queries raised by the Payers.   Work in coordination with the RCM Manager to support claims reconciliation, payer audits, and other assigned activities.     Training and Reporting:   Support in Daily reporting and preparing denial and submission reports Support coding and compliance training and provide training materials and support to Claims processors – Submission & Resubmission and clinical team regarding ICD/CPT and other medical coding requirements. Provide timely feedback about rectification of the denials related to Coding, billing and approvals.   General Responsibilities   Maintain confidentiality of patient, clinical, and insurance information. Adhere strictly to hospital policies, payer requirements, and regulatory guidelines. Accurately enter and maintain coding data in hospital billing systems. Be available to clinicians and internal stakeholders for ICD/CPT clarification and coding support. Perform any additional RCM-related tasks as assigned by the RCM Manager.