Key Responsibilities:

• Ensure adherence to the laid down SOPs in IP/OP Claims management.
• Ensuring that all the insurance company requirements are met before claims are submitted
• Ensuring the discharge procedure authorization and billing closing procedures are followed and appropriate approval and sign off is obtained.
• Ensuring all IP bill and SHIF OP bills are properly closed in HMIS before submission to Finance Claims Office.
• Ensure complete set of claims processing documents and bill is sent to Finance Claims Office within 24 hours of patient discharge or receipt from OP for SHIF OP bills.
• Maintain a file of the IP/OP checklists.
• Sending daily status report of all corporate and cash IPs to credit control.
• Sending daily status report to corporates and insurance escalating any situation where patient LOU/Pre-Auth limit is likely to be exceeded within the next 24 hours to request for increase/top up in limit or if not engage patient on cash payment to top up.
• Weekly report on finalized invoices forwarded to Finance Claims and Credit Control and written in the control book.
• 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 and clear case notes and discharge summary, membership/policy number, claims are within the limit) and presence of smart reports where applicable.

Qualifications & Experience:

• Degree in Finance or Accounting or ACCA Part 2/CPA K Part/Sec 2 or above
• 2 years accounting experience preferably in hospital setup.

Key Competencies:

• Self-Motivated, Dedicated, Leadership Skills, People-Skills, Honest, Ethical.

• Ensure adherence to the laid down SOPs in IP/OP Claims management.
• Ensuring that all the insurance company requirements are met before claims are submitted
• Ensuring the discharge procedure authorization and billing closing procedures are followed and appropriate approval and sign off is obtained.
• Ensuring all IP bill and SHIF OP bills are properly closed in HMIS before submission to Finance Claims Office.
• Ensure complete set of claims processing documents and bill is sent to Finance Claims Office within 24 hours of patient discharge or receipt from OP for SHIF OP bills.
• Maintain a file of the IP/OP checklists.
• Sending daily status report of all corporate and cash IPs to credit control.
• Sending daily status report to corporates and insurance escalating any situation where patient LOU/Pre-Auth limit is likely to be exceeded within the next 24 hours to request for increase/top up in limit or if not engage patient on cash payment to top up.
• Weekly report on finalized invoices forwarded to Finance Claims and Credit Control and written in the control book.
• 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 and clear case notes and discharge summary, membership/policy number, claims are within the limit) and presence of smart reports where applicable.

• Self-Motivated
• Dedicated
• Leadership Skills
• People-Skills
• Honest
• Ethical

• Degree in Finance or Accounting or ACCA Part 2/CPA K Part/Sec 2 or above
• 2 years accounting experience preferably in hospital setup.