Claims Assurance Officer - Kakamega
2025-06-06T15:28:10+00:00
Avenue Healthcare
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https://www.avenuehealthcare.com/
FULL_TIME
Kakamega
Kakamega
00100
Kenya
Healthcare
Finance, Insurance & Real Estate
2025-06-12T17:00:00+00:00
Kenya
8
Main Purpose of the Job- (Job Summary)
- To ensure accurate and complete documentation for insurance and direct credit outpatient (OP) claims, minimize payer rejections, and enhance revenue assurance at the point of service through effective coordination between the reception, medical, and credit teams.
Main Responsibilities
Claims Documentation & Assurance
- Verify completeness and accuracy of insurance documentation prior to service delivery.
- Ensure insurance and patient details are correctly entered in the system.
- Validate pre-authorizations, NHIF codes, QR codes, diagnosis, and required claim attachments.
Front Office Oversight
- Supervise client service teams to ensure compliance with billing and documentation SOPs.
- Conduct ongoing training on insurance procedures, documentation standards, and system updates.
Rejection Prevention
- Analyze claim rejection trends and address root causes.
- Identify high-risk claims and escalate incomplete or inconsistent documentation for immediate resolution.
Interdepartmental Coordination
- Act as liaison between clinical, reception, and finance departments to ensure seamless documentation flow.
- Coordinate with insurance providers for clarifications or additional documentation needs.
Reporting & Audit
- Prepare daily and weekly reports on documentation compliance, rejection metrics, and flagged claims.
- Support internal audits and help implement corrective action plans to improve claims quality.
Financial & Operational Oversight
- Monitor invoicing reports, banking transactions, and Oracle purchases.
- Assist in cost optimization initiatives and ensure inventory accuracy.
Customer Experience
- Resolve patient concerns regarding billing and documentation professionally.
- Support a patient-first approach by ensuring clarity and transparency in the billing process.
- Perform any additional duties as assigned by management to support the revenue assurance function.
Key Deliverables of this position
- 100% accuracy and completeness of insurance and credit documentation before delivery of service.
- Reduction in claim rejections through proactive documentation checks and SOP compliance.
- Effective coordination across departments to ensure timely claims submission and revenue assurance.
Essential
- Higher Diploma or Diploma in Health Records, Business Administration, or a related field.
Desirable
- CPA, ACCA, Diploma in accounting or any other relevant training in accounting, relevant bachelor’s degree, or a related field.
Work Experience & Skills
Essential
- Minimum 3 years of experience in a medical billing/revenue cycle role, preferably in a hospital or insurance setting.
Desirable
- Knowledge of medical insurance procedures in Kenya (including SHA/SHIF, private insurance payers, etc.).
Key Competencies
Essential
- Knowledge of medical billing software and EMR systems
- Strong attention to detail and accuracy
- Problem-solving and critical thinking abilities
- Excellent communication and interpersonal skills
Desirable
- Ability to work in a fast-paced environment and under pressure
Claims Documentation & Assurance Verify completeness and accuracy of insurance documentation prior to service delivery. Ensure insurance and patient details are correctly entered in the system. Validate pre-authorizations, NHIF codes, QR codes, diagnosis, and required claim attachments. Front Office Oversight Supervise client service teams to ensure compliance with billing and documentation SOPs. Conduct ongoing training on insurance procedures, documentation standards, and system updates. Rejection Prevention Analyze claim rejection trends and address root causes. Identify high-risk claims and escalate incomplete or inconsistent documentation for immediate resolution. Interdepartmental Coordination Act as liaison between clinical, reception, and finance departments to ensure seamless documentation flow. Coordinate with insurance providers for clarifications or additional documentation needs. Reporting & Audit Prepare daily and weekly reports on documentation compliance, rejection metrics, and flagged claims. Support internal audits and help implement corrective action plans to improve claims quality. Financial & Operational Oversight Monitor invoicing reports, banking transactions, and Oracle purchases. Assist in cost optimization initiatives and ensure inventory accuracy. Customer Experience Resolve patient concerns regarding billing and documentation professionally. Support a patient-first approach by ensuring clarity and transparency in the billing process. Perform any additional duties as assigned by management to support the revenue assurance function.
Higher Diploma or Diploma in Health Records, Business Administration, or a related field. Desirable CPA, ACCA, Diploma in accounting or any other relevant training in accounting, relevant bachelor’s degree, or a related field. Work Experience & Skills Essential Minimum 3 years of experience in a medical billing/revenue cycle role, preferably in a hospital or insurance setting.
JOB-6843090af3193
Vacancy title:
Claims Assurance Officer - Kakamega
[Type: FULL_TIME, Industry: Healthcare, Category: Finance, Insurance & Real Estate]
Jobs at:
Avenue Healthcare
Deadline of this Job:
Thursday, June 12 2025
Duty Station:
Kakamega | Kakamega | Kenya
Summary
Date Posted: Friday, June 6 2025, Base Salary: Not Disclosed
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JOB DETAILS:
Main Purpose of the Job- (Job Summary)
- To ensure accurate and complete documentation for insurance and direct credit outpatient (OP) claims, minimize payer rejections, and enhance revenue assurance at the point of service through effective coordination between the reception, medical, and credit teams.
Main Responsibilities
Claims Documentation & Assurance
- Verify completeness and accuracy of insurance documentation prior to service delivery.
- Ensure insurance and patient details are correctly entered in the system.
- Validate pre-authorizations, NHIF codes, QR codes, diagnosis, and required claim attachments.
Front Office Oversight
- Supervise client service teams to ensure compliance with billing and documentation SOPs.
- Conduct ongoing training on insurance procedures, documentation standards, and system updates.
Rejection Prevention
- Analyze claim rejection trends and address root causes.
- Identify high-risk claims and escalate incomplete or inconsistent documentation for immediate resolution.
Interdepartmental Coordination
- Act as liaison between clinical, reception, and finance departments to ensure seamless documentation flow.
- Coordinate with insurance providers for clarifications or additional documentation needs.
Reporting & Audit
- Prepare daily and weekly reports on documentation compliance, rejection metrics, and flagged claims.
- Support internal audits and help implement corrective action plans to improve claims quality.
Financial & Operational Oversight
- Monitor invoicing reports, banking transactions, and Oracle purchases.
- Assist in cost optimization initiatives and ensure inventory accuracy.
Customer Experience
- Resolve patient concerns regarding billing and documentation professionally.
- Support a patient-first approach by ensuring clarity and transparency in the billing process.
- Perform any additional duties as assigned by management to support the revenue assurance function.
Key Deliverables of this position
- 100% accuracy and completeness of insurance and credit documentation before delivery of service.
- Reduction in claim rejections through proactive documentation checks and SOP compliance.
- Effective coordination across departments to ensure timely claims submission and revenue assurance.
Essential
- Higher Diploma or Diploma in Health Records, Business Administration, or a related field.
Desirable
- CPA, ACCA, Diploma in accounting or any other relevant training in accounting, relevant bachelor’s degree, or a related field.
Work Experience & Skills
Essential
- Minimum 3 years of experience in a medical billing/revenue cycle role, preferably in a hospital or insurance setting.
Desirable
- Knowledge of medical insurance procedures in Kenya (including SHA/SHIF, private insurance payers, etc.).
Key Competencies
Essential
- Knowledge of medical billing software and EMR systems
- Strong attention to detail and accuracy
- Problem-solving and critical thinking abilities
- Excellent communication and interpersonal skills
Desirable
- Ability to work in a fast-paced environment and under pressure
Work Hours: 8
Experience in Months: 36
Level of Education: bachelor degree
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