Background

Established in 1997, Lion's SightFirst Eye Hospital is among the leading Eye hospitals in East & Central Africa. We are located in the serene Loresho neighborhood, 25 minutes from the Nairobi CBD. We also offer Dental, ENT & Diabetes healthcare services.

Job Purpose

The Biller is responsible for ensuring accurate, complete, timely, and compliant billing for hospital services. The role supports the hospital revenue cycle by ensuring that all chargeable services are captured, patient accounts are accurately maintained, insurance claims are properly prepared and followed up, and billing-related issues are resolved.

Key Duties and Responsibilities

• Generate accurate patient bills for outpatient and inpatient services.
• Ensure consultations, procedures, investigations, medications, consumables, and other chargeable services are captured and billed.
• Verify charges against approved hospital tariffs and investigate billing discrepancies.
• Review patient accounts for completeness before discharge or account closure.
• Prepare invoices, statements, receipts, and other billing documentation as required.
• Verify insurance or medical scheme eligibility and benefit information where applicable.
• Ensure required pre-authorisations are obtained and appropriately documented.
• Prepare and submit accurate insurance and third-party claims within agreed timelines.
• Follow up outstanding, rejected, queried, and denied claims and coordinate corrections and resubmissions.
• Maintain an updated claims follow-up register and support reduction of aged receivables.
• Work closely with clinical, nursing, pharmacy, laboratory, radiology, theatre, medical records, insurance, and finance teams to ensure complete capture of services.
• Identify recurring billing errors, revenue leakage, and process gaps and escalate them appropriately.
• Accurately enter and maintain billing information in the hospital information system.
• Maintain confidentiality of patient, insurance, and financial information.
• Prepare regular billing, claims, reconciliation, outstanding balance, and exception reports.
• Support implementation and continuous improvement of hospital revenue-cycle processes.

Qualifications and Experience

• Bachelor’s Degree or Diploma in Accounting, Finance, Business Administration, Health Administration, or a related field.
• Training or certification in medical billing, insurance claims, healthcare finance, or revenue-cycle management is an advantage.
• Minimum of two (2) years’ relevant experience in hospital billing, medical insurance claims, revenue cycle, healthcare finance, or a related environment.
• Experience with medical insurance and third-party payer processes is strongly preferred.
• Experience using hospital information management or billing systems is preferred.

Required Skills and Competencies

• Strong knowledge of hospital billing and revenue-cycle processes.
• Understanding of medical insurance and claims procedures.
• Good understanding of hospital tariffs, invoicing, reconciliation, and payment processes.
• Proficiency in Microsoft Office applications, particularly Excel, and hospital information systems.
• Strong numerical, analytical, and problem-solving abilities.
• Excellent attention to detail and accuracy.
• Strong written, verbal, and interpersonal communication skills.
• Ability to manage confidential information with integrity.
• Good planning, organization, time management, and follow-up skills.
• Ability to work under pressure and meet billing and claims deadlines.
• High level of professionalism, accountability, and customer service orientation.

Expected Outcomes

• Accurate and complete patient bills generated within required timelines.
• Improved accuracy and timeliness of insurance and third-party claims.
• Reduced claim rejection, denial, and resubmission rates.
• Reduced billing errors and revenue leakage.
• Timely identification and resolution of billing discrepancies.
• Accurate reconciliation of billing records and payments.
• Improved monitoring and follow-up of outstanding patient and insurance balances.
• Reliable billing and claims reports available for management decision-making.
• Improved compliance with approved hospital tariffs, billing procedures, and financial controls.
• Improved patient experience in relation to billing and payment processes.

• Generate accurate patient bills for outpatient and inpatient services.
• Ensure consultations, procedures, investigations, medications, consumables, and other chargeable services are captured and billed.
• Verify charges against approved hospital tariffs and investigate billing discrepancies.
• Review patient accounts for completeness before discharge or account closure.
• Prepare invoices, statements, receipts, and other billing documentation as required.
• Verify insurance or medical scheme eligibility and benefit information where applicable.
• Ensure required pre-authorisations are obtained and appropriately documented.
• Prepare and submit accurate insurance and third-party claims within agreed timelines.
• Follow up outstanding, rejected, queried, and denied claims and coordinate corrections and resubmissions.
• Maintain an updated claims follow-up register and support reduction of aged receivables.
• Work closely with clinical, nursing, pharmacy, laboratory, radiology, theatre, medical records, insurance, and finance teams to ensure complete capture of services.
• Identify recurring billing errors, revenue leakage, and process gaps and escalate them appropriately.
• Accurately enter and maintain billing information in the hospital information system.
• Maintain confidentiality of patient, insurance, and financial information.
• Prepare regular billing, claims, reconciliation, outstanding balance, and exception reports.
• Support implementation and continuous improvement of hospital revenue-cycle processes.

• Strong knowledge of hospital billing and revenue-cycle processes.
• Understanding of medical insurance and claims procedures.
• Good understanding of hospital tariffs, invoicing, reconciliation, and payment processes.
• Proficiency in Microsoft Office applications, particularly Excel, and hospital information systems.
• Strong numerical, analytical, and problem-solving abilities.
• Excellent attention to detail and accuracy.
• Strong written, verbal, and interpersonal communication skills.
• Ability to manage confidential information with integrity.
• Good planning, organization, time management, and follow-up skills.
• Ability to work under pressure and meet billing and claims deadlines.
• High level of professionalism, accountability, and customer service orientation.

• Bachelor’s Degree or Diploma in Accounting, Finance, Business Administration, Health Administration, or a related field.
• Training or certification in medical billing, insurance claims, healthcare finance, or revenue-cycle management is an advantage.
• Minimum of two (2) years’ relevant experience in hospital billing, medical insurance claims, revenue cycle, healthcare finance, or a related environment.
• Experience with medical insurance and third-party payer processes is strongly preferred.
• Experience using hospital information management or billing systems is preferred.