Job Description
- Lead, coach, and manage the Submission & Resubmission team to achieve departmental KPIs.
- Monitor daily submission and resubmission activities to ensure accuracy and timeliness.
- Review rejected or returned submissions, identify root causes, and implement corrective actions.
- Develop and maintain standard operating procedures (SOPs) for submission workflows.
- Ensure compliance with company policies, payer/client requirements, and applicable regulations.
- Coordinate with internal departments such as Operations, Quality, Billing, Coding, Customer Service, and IT to resolve submission-related issues.
- Analyze submission trends, rejection patterns, and team performance metrics.
- Prepare daily, weekly, and monthly operational reports for management.
- Conduct quality audits and provide feedback and training to team members.
- Drive process improvement initiatives to enhance productivity and reduce turnaround time.
- Manage workload distribution and resource planning to meet service-level agreements (SLAs).
- Support system upgrades, process automation, and implementation of new workflows.
Responsibilities
- Lead, coach, and manage the Submission & Resubmission team to achieve departmental KPIs.
- Monitor daily submission and resubmission activities to ensure accuracy and timeliness.
- Review rejected or returned submissions, identify root causes, and implement corrective actions.
- Develop and maintain standard operating procedures (SOPs) for submission workflows.
- Ensure compliance with company policies, payer/client requirements, and applicable regulations.
- Coordinate with internal departments such as Operations, Quality, Billing, Coding, Customer Service, and IT to resolve submission-related issues.
- Analyze submission trends, rejection patterns, and team performance metrics.
- Prepare daily, weekly, and monthly operational reports for management.
- Conduct quality audits and provide feedback and training to team members.
- Drive process improvement initiatives to enhance productivity and reduce turnaround time.
- Manage workload distribution and resource planning to meet service-level agreements (SLAs).
- Support system upgrades, process automation, and implementation of new workflows.
Qualifications
- Bachelor’s degree in Business Administration, Healthcare Management, Finance, or a related field.
- 3–5+ years of experience in submission, claims processing, revenue cycle, or related operations.
- At least 1–2 years of team leadership or supervisory experience.
- Experience with claims management or submission systems is preferred.
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