Submission & Resubmission Officer

Audit and review medical claims, medical records, and supporting documentation to substantiate rejected services and ensure compliance with regulatory and claim adjudication rules. Process and manage resubmission of rejected claims according to payer guidelines and organizational procedures, maintaining accuracy for successful reimbursement. Verify agreed price lists and provider manuals, coordinate with physicians when justification is needed, update billing teams on rejections, and submit claims with proper codes and formatting within timelines.