Submission & Resubmission Officer
NMC Healthcare · Sharjah
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.
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