Responsibilities

• Review and audit medical claims to ensure accuracy, completeness, and compliance with payer requirements.
• Manage the resubmission of rejected claims, ensuring all necessary corrections and supporting documentation are provided.
• Ensure adherence to agreed pricing lists, provider manuals, and insurance company guidelines when billing services to respective payers.
• Communicate claim rejections to Billing Officers in a timely manner and implement corrective actions to minimize future occurrences.
• Coordinate with physicians and other stakeholders to obtain clinical justifications and supporting documentation for claim resubmissions when required.
• Submit claims using appropriate coding standards and formats within the stipulated timelines established by insurance companies.
• Maintain compliance with regulatory requirements, payer policies, and organizational standards related to medical claims p...