Resubmission Officer Fakeeh Care Group

JOB PURPOSE:

To ensure efficient management and resolution of claims denials and reconciliation for cash and credit patients, focusing on timely, accurate, and cost-effective processes in alignment with established guidelines.

KEY RESPONSIBILITIES AND DUTIES:

Reviews adjudicated claims for accuracy and final resolution.

Issues adjusted, corrected, or rebilled claims to insurance companies as needed.

Analyzes claims denials and performs necessary appeals to secure appropriate reimbursement. 

Submits insurance appeals in a timely manner and follows up to ensure receipt and processing by insurers.

Communicates directly with payers to resubmit denied claims, underpaid claims, or claims processed inaccurately. 

Identifies, documents, and reports trends in recurring denials, suggesting process improvements or system edits to prevent future issues. 

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Oversees Medicaid audits and ensures all required documentation is provided. 

Reviews and prepares monthly system reports for leadership, highlighting key trends and updates. 

Prepares an analytical summary report identifying areas of concern by dollar amount, claim volume, and new denials. 

Tracks the improvement of targeted denials once process or system edits have been implemented to reduce or prevent future denials. 

Collaborates with other departments to ensure maximum productivity and efficient resolution of denials. 

Other duties as assigned within the scope of the job.

Experience:

Bachelor’s degree in Life Sciences, Nursing, Paramedical, or related medical field.

Certified medical coder (CPC, CCS, CPMA – AAPC/AHIMA preferred).

1–2 years of hospital claims resubmission experience in Dubai/Abu Dhabi.

3 years of experience in denial management, claims reconciliation, revenue cycle management or a related field.

Strong experience in denial management, appeals, and insurance audits.

Knowledge of ICD-10, CPT, HCPCS, DRG, and DHA billing systems.

Good skills in Microsoft Excel and office applications.

Strong analytical, communication, and problem-solving skills.

Responsible for denied claim review, resubmission, compliance, documentation tracking, and coordination with physicians/coders for supporting documents.

OTHERS:

The job description is subject to periodic review and may be updated as necessary. All job descriptions must be reviewed every 3 years or more often as deemed applicable to ensure they remain relevant.

COMPETENCIES:

Adaptability & Resilience

Accountability & Role Understanding with Accreditation Knowledge

Teamwork and Relationship Building with Cultural Alignment

Talent Management and Development

Compassionate and Effective Communication