Medical, Healthcare, Finance, Accounting, Audit,
Claims Vetting Officer-Clinical
JOB PURPOSE
The Clinical Vetting officer will safeguard the company’s revenue by ensuring that all the necessary medical services in the patient care journey both for Inpatient and Outpatient billings are supported for the general and specific insurance guidelines including diagnosis, pharmacy, lab requests, nursing services, nutrition, radiology, doctors’ specialist, ambulance, and physiotherapy.
MAIN DUTIES AND RESPONSIBILITIES
- Create and implement a billing guide with checkpoints that can guide revenue officers on any under billings or over billings.
- Act as interface and Communicate with Patients, Doctors, and departments regarding professional billing and claims operations.
- Work with appropriate departments to create appropriate hospital packages (Inpatient and Outpatient) and the continuous review of the same to ensure that they remain competitive by benchmarking against similar systems.
- Review capitation/fixed cost bills to ensure justification of crossed bills.
- Ensure that all billings for services including procedure fees, doctor’s fees and support services like ambulance and nursing fees are as per agreed and contracted rates and communicating to insurances on patient management and care.
- Confirm a clear and adequate diagnosis has been attached both on the physical documentation and the online platforms to support the pharmacy, lab, specialist, and other support services and that the same are payable by the insurance and advice on preauthorization.
- Ensure that all drugs and non-pharmaceutical products dispensed are not exclusions for the general and specific insurance guidelines.
- Correct any medical mismatch between diagnosis and treatment or procedure requests before dispatch.
- Respond to insurance clinical queries arising from time to time.
MINIMUM REQUIREMENTS/ QUALIFICATIONS
- Degree/Diploma in nursing or clinical Medicine from a reputable institution.
- Basic understanding of the concepts of insurance.
- Finance or Accounting training will be an added advantage.
- 2-3 Years’ experience in handling claims in a busy hospital.
KEY JOB REQUIREMENTS
- Honesty, transparency, and integrity
- Excellent customer service skills.
- Effective communication skills – listening, oral and written.
- Good interpersonal skills and a team player.
- Ability to work under pressure with minimum supervision.
- Analytical and decision-making skills.
- Report writing and presentation skills.
- Desire for personal development, improvement, and learning.
Claims Vetting Officer- Non-Clinical
JOB PURPOSE
The Claims Vetting officer will safeguard the company’s revenue by ensuring the following: that all physical claims and online billing platforms reflect the correct documentation, data input and attachments to support the claim including Diagnosis, claim forms, billing amounts, member details, and benefit utilization by ensuring that all insurance guidelines on scheme have been followed to ensure adherence to SLA as per contract for all insurance, corporate and NHIF billings.
MAIN DUTIES AND RESPONSIBILITIES
- Perform review of patient identification documents for authenticity.
- Ensure all the required claim documents are filled in by patients and doctors for forwarding to the insurance and the correct documentation is reflected on all online platforms.
- Confirm complete processing of all outpatient and inpatient documents received before dispatch.
- Liaise with other departments in resolving problems with respect to invoices, claim documentation and online billings.
- Ensure completeness and accuracy of claims and invoices (ensuring pre-authorization and/or LOU, signing by the doctor and client claim and bill, presence of diagnosis, co-pay and clear case notes and discharge summary, membership/policy number, claim is within the limit) and presence of smart reports and off smarts where applicable.
- Ensure all IDS (Internal Dispatch Summary Reports) are acknowledged via signing and a copy scanned and filed.
MINIMUM REQUIREMENTS/ QUALIFICATIONS
- Bachelor’s in business administration -Finance option/ Higher Diploma in Business Administration- finance option or its equivalent.
- CPAK/CCP Professional
- Proficiency in MS Office Suite (Excel, Word, and PowerPoint).
- 2-3 Years’ experience in handling claims in a busy hospital.
KEY JOB REQUIREMENTS
- Honesty, transparency, and integrity
- Excellent customer service skills.
- Effective communication skills – listening, oral and written.
- Good interpersonal skills and a team player.
- Ability to work under pressure with minimum supervision.
- Analytical and decision-making skills.
- Report writing and presentation skills.
- Desire for personal development, improvement, and learning.
Claims Vetting Officer- Non-Clinical (Dispatch Officer)
JOB PURPOSE
The Dispatch officer will safeguard the company’s revenue by ensuring that all finalized invoices are correctly documented both physically and on online platforms and are timely shared with the correct recipients and documented for reference.
MAIN DUTIES AND RESPONSIBILITIES
- Liaise with the Revenue /Claims Vetting Officers in resolving problems with respect to un-dispatched invoices.
- Record and review all incomplete invoices for reporting and follow-up.
- Maintain records and keep safe custody of all dispatch files i.e physical dispatch sheets.
- Prepare a daily, weekly, and monthly report on invoices status.
MINIMUM REQUIREMENTS/ QUALIFICATIONS
- Degree in finance/accounting or its equivalent from a reputable institution.
- CPA part 2
- Insurance training will be an added advantage.
- 2-3 Years’ experience in handling claims in a busy hospital.
KEY JOB REQUIREMENTS
- Honesty, transparency, and integrity
- Excellent customer service skills.
- Effective communication skills – listening, oral and written.
- Good interpersonal skills and a team player.
- Ability to work under pressure with minimum supervision.
- Analytical and decision-making skills.
- Report writing and presentation skills.
- Desire for personal development, improvement, and learning.
Method of Application
If your background, experience and competence match the above specifications, please send us your application (cover letter & CV/Resume) quoting the job title on the email subject your current and expected remuneration, testimonials and full contact details of 3 referees, to careers@premierhospital.org. The application should be received not later than 5.00pm on 25th October 2023. We shall ONLY accept ONLINE applications. Interviews will be conducted on a rolling basis. Due to the high number of applications, only shortlisted candidates will be contacted.