Background information about the job or company (e.g., role context, company overview)

Valley Hospital is a premier health facility located in Nakuru, offering diverse services with a mission to provide quality yet affordable healthcare.

Responsibilities or duties

Insurance/corporate Pre-authorisation & Authorization Management

• Oversee and review all outpatient pre-authorisation requests submitted to insurance/corporate companies including Social Health Authority (SHA), ensuring accuracy, completeness, and timeliness
• Supervise the end-to-end inpatient authorization process from initial submission through to approval, including management of pending cases and escalation of disputes
• Maintain up-to-date knowledge of payer policies, SHA protocols, and benefit schedules to guide the team on correct claim coding and authorization submission
• Monitor authorization turnaround times and flag delays that may affect patient care or revenue flow, escalating to clinical or finance teams as needed
• Liaise directly with insurance/corporate case managers/contacts and SHA relationship officers to resolve disputes, obtain extensions, and manage complex or high-cost authorizations

Admissions Management

• Supervise the admission of all referred patients from external healthcare facilities, ensuring proper documentation, clinical handover protocols, and bed allocation are coordinated promptly
• Manage the conversion process for outpatients requiring inpatient admission, ensuring a seamless transition without disruption to the patient experience or clinical workflow
• Verify completeness of all admission documentation including referral letters, patient identification, insurance/corporate eligibility checks, and deposit or guarantee letters where applicable
• Coordinate with clinical departments, nursing, and housekeeping to manage bed availability and expected admissions, minimizing patient waiting times
• Ensure all admissions are captured accurately and in real time on the Hospital Management Information System (HMIS)

Discharge Coordination

• Oversee the discharge process to ensure timely clearance of patients, including final billing reconciliation, insurance/corporate sign-off, and collection of outstanding patient balances
• Coordinate with nursing, pharmacy, and finance teams to resolve pre-discharge holds and confirm discharge summaries are complete before patient departure
• Monitor average length-of-stay data and work with clinical teams to reduce avoidable delays in discharge

Team Leadership & Department Oversight

• Directly supervise and performance-manage all staff within the Admissions & Discharges Office across all shifts, including weekends and public holidays
• Prepare duty rosters ensuring adequate coverage at all times; manage leave, absenteeism, and overtime within approved thresholds
• Identify training needs and facilitate on-the-job coaching and structured development to maintain team competency and service quality
• Conduct regular team briefings and performance reviews, documenting outcomes and escalating HR matters as appropriate
• Foster a culture of accuracy, accountability, and patient-centred service

Metrics, Reporting & Analytics

• Track and report on key performance indicators including pre-authorisation approval rates, denial/rejection rates, admissions volumes, OP-to-IP conversion rates, and discharge turnaround times
• Prepare daily, weekly, and monthly operational reports for the Head of Patient Services and senior management
• Identify trends and recommend operational or policy changes to improve authorization approval rates and reduce admission delays

Process Improvement & Compliance

• Implement process changes to reduce authorization errors and shorten the patient admission-to-discharge cycle
• Ensure compliance with healthcare regulations, insurance/corporate contractual obligations, SHA requirements, and internal administrative controls
• Collaborate with clinical, billing, and finance teams to close gaps at the point of patient registration, authorization, and discharge documentation

Qualifications or requirements (e.g., education, skills)

Key Competencies

• Analytical thinking and attention to detail
• Strong communication and negotiation skills
• Leadership and team development
• Process improvement orientation
• Patient-centred service mindset and understanding of healthcare operations

Requirements

• Diploma or Bachelor’s degree in Health Records & Information Management, Business Administration (Healthcare), Nursing, or a related field
• Proficiency in a Hospital Management Information System (HMIS); familiarity with SHA and private insurer authorization platforms
• Working knowledge of Kenya’s Social Health Insurance, private insurance/corporate framework (SHA) and insurance/corporate panel processes
• Training in medical billing or insurance/corporate claims processing is an added advantage

Experience needed

Minimum 3 years’ experience in a hospital front office, admissions, or medical billing environment.

Any other provided details (e.g., benefits, work environment, team info, or additional notes)

Never pay for any notarisation, certificate or assessment as part of any recruitment process. When in doubt, contact us

• Oversee and review all outpatient pre-authorisation requests submitted to insurance/corporate companies including Social Health Authority (SHA), ensuring accuracy, completeness, and timeliness
• Supervise the end-to-end inpatient authorization process from initial submission through to approval, including management of pending cases and escalation of disputes
• Maintain up-to-date knowledge of payer policies, SHA protocols, and benefit schedules to guide the team on correct claim coding and authorization submission
• Monitor authorization turnaround times and flag delays that may affect patient care or revenue flow, escalating to clinical or finance teams as needed
• Liaise directly with insurance/corporate case managers/contacts and SHA relationship officers to resolve disputes, obtain extensions, and manage complex or high-cost authorizations
• Supervise the admission of all referred patients from external healthcare facilities, ensuring proper documentation, clinical handover protocols, and bed allocation are coordinated promptly
• Manage the conversion process for outpatients requiring inpatient admission, ensuring a seamless transition without disruption to the patient experience or clinical workflow
• Verify completeness of all admission documentation including referral letters, patient identification, insurance/corporate eligibility checks, and deposit or guarantee letters where applicable
• Coordinate with clinical departments, nursing, and housekeeping to manage bed availability and expected admissions, minimizing patient waiting times
• Ensure all admissions are captured accurately and in real time on the Hospital Management Information System (HMIS)
• Oversee the discharge process to ensure timely clearance of patients, including final billing reconciliation, insurance/corporate sign-off, and collection of outstanding patient balances
• Coordinate with nursing, pharmacy, and finance teams to resolve pre-discharge holds and confirm discharge summaries are complete before patient departure
• Monitor average length-of-stay data and work with clinical teams to reduce avoidable delays in discharge
• Directly supervise and performance-manage all staff within the Admissions & Discharges Office across all shifts, including weekends and public holidays
• Prepare duty rosters ensuring adequate coverage at all times; manage leave, absenteeism, and overtime within approved thresholds
• Identify training needs and facilitate on-the-job coaching and structured development to maintain team competency and service quality
• Conduct regular team briefings and performance reviews, documenting outcomes and escalating HR matters as appropriate
• Foster a culture of accuracy, accountability, and patient-centred service
• Track and report on key performance indicators including pre-authorisation approval rates, denial/rejection rates, admissions volumes, OP-to-IP conversion rates, and discharge turnaround times
• Prepare daily, weekly, and monthly operational reports for the Head of Patient Services and senior management
• Identify trends and recommend operational or policy changes to improve authorization approval rates and reduce admission delays
• Implement process changes to reduce authorization errors and shorten the patient admission-to-discharge cycle
• Ensure compliance with healthcare regulations, insurance/corporate contractual obligations, SHA requirements, and internal administrative controls
• Collaborate with clinical, billing, and finance teams to close gaps at the point of patient registration, authorization, and discharge documentation

• Analytical thinking and attention to detail
• Strong communication and negotiation skills
• Leadership and team development
• Process improvement orientation
• Patient-centred service mindset and understanding of healthcare operations

• Diploma or Bachelor’s degree in Health Records & Information Management, Business Administration (Healthcare), Nursing, or a related field
• Proficiency in a Hospital Management Information System (HMIS); familiarity with SHA and private insurer authorization platforms
• Working knowledge of Kenya’s Social Health Insurance, private insurance/corporate framework (SHA) and insurance/corporate panel processes
• Training in medical billing or insurance/corporate claims processing is an added advantage