Resubmission Supervisor
Job Description
The Resubmission supervisor ensures the filing and tracking of insurance claims and informing patients of their claims status. Involved in Processing insurance and disability claims in a timely manner & prepares all insurance forms and associated correspondences. Analyzes the rejections, requests justifications & follow ups with the concerned doctors on regular basis for closure.
Responsibilities
- Liaises with treating physicians to receive properly completed justification of received rejections claim form requests for services which require approvals as per policy terms and conditions.
- Process the claims within a reasonable time frame within SLA and meeting the set KPIs;
- Handle relationships with clients and brokers regarding reimbursement claims by asking for additional information whenever required, by explaining the details of the settlements (i.e. application of the deductible and coverage, justify rejections and uncovered expense);
- Expedites the submission of Insurance claims, collection of receivables and resubmission of rejected claims.
- Adjudicate and approve justified claims within the policy limits set and to refer cases to the claims manager for approval where authority limits are exceeded.
- Interpret and process claims using knowledge of ICD codes, billing, benefits, and company policies.
- Proactively report critical issues to the Claims manager.
- Prepares periodic medical and financial rejection reports.
- Strives to reduce the amount of Rejected claims.
- Prepares monthly reports of claims, Audit’s key indicators with amount of claims individually mentioned.
- Follow up with treating doctors & gets the precise justification to respond back to insurance companies.(related to 1)
- To respond to and liaise as required with insurance companies and network providers in a professional and courteous manner.
- Assist with Claims Data Analysis and Quality Assurance as requested.
- Work collaboratively within the audit team as well as with internal and external customers.
- Provides feedback to Manager, Claims Network and Information System departments of findings to improve quality.
- Participates in weekly departmental meetings for updates and new processes.
- Enhances professional growth of self through participation in training programs, current literature and in service meetings
- . Attends meetings as required.
- Performs other related duties as assigned by the Manager- Insurance.
