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

Penda Health is an award-winning startup company that is transforming healthcare in East Africa by building a chain of outpatient health clinics that offer evidence-based medical care and unparalleled member experience at surprisingly affordable rates. Penda is ranked the Best Health Care Firm to work for in Kenya and the #26 Best company to work in Kenya...

Role Summary

Reporting to the Senior Manager – Credit Control, the Credit Controller coordinates all credit control operations for the assigned partner accounts within the credit portfolio through implementation of effective collection strategies and strong relationship management, and being accountable for the processing and submission of invoices, collection and allocation of payments, and reconciliation of accounts, as well as leading the credit team, enforcing compliance with credit policies, monitoring receivables and key performance indicators, which will help with sustaining optimal cash flow in alignment with the hospital’s financial objectives and stewardship principles.

Responsibilities or duties

• Ensure that all insurance invoices are submitted to the payors within 7 days after an invoice was generated and 48 hours for all online submissions.
• Ensure that all insurance statements are sent to the insurance and corporate partners by the 6th of every month.
• Ensure accurate and timely submission of an aging report by 8th of every month clearing indicating the receivable days across all payors and across the overall debtors outstanding.
• Reconciliation reports for all payors should be sent to the Credit Control Manager by 15th of every month for review.
• Rejected claims reports for all signed off accounts should be shared with the Senior Manager Credit control at the end of every quarter for review and approvals.
• Prepare periodic reports on collection trends, key account performance, and credit risk analysis for the assigned accounts.
• Support internal and external audits by providing requested credit documentation and reconciliations where necessary.
• AR Reconciliation Accuracy Rate of ≥ 99.5% accuracy in matching the receivable accounts, insurer statements, and AR sub-ledger balances, with less than 0.5% material variances.
• All accounts receivables should be reconciled monthly and all due invoices not paid should be paid within the next payment cycle if they do not have any underlying issues that delays their payment.
• Ensure that the rejected claims are maintained at below 0.5% of the total outstanding during every sign off.
• Rejected claims review should be done on a monthly basis and reports of the same submitted to the Medical billing Manager for review by 15th of every month.
• Conduct quarterly sign offs for all assigned receivable accounts.
• Ensure that over 90% of all identified underpayments and non Penda reconciled items are settled claims within 45 days of identification.
• Provide technical system support on SHA billing processes in liaison with the Medical Billing Manager.
• Build and maintain strong working relationships with the Social Health Authority to support timely settlement of outstanding claims.
• Prepare and maintain monthly SHA reports for all branches, highlighting variances between the Penda EMR records and actual submissions on the SHA portal.
• Ensure timely submission of SHA revenue reports before 4th of every month.
• Follow up on collections for amounts owed to Penda by the Social Health Insurance (SHA)

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

• Advanced Diploma in Finance, Business Management, Insurance, or a related field, with progress toward or completion of a relevant professional certification (e.g., CPA III, ACCA, or equivalent).
• Excellent interpersonal and communication skills.
• Self-motivated with ability to work well under pressure
• Track record in achieving financial reporting deadlines.
• Capable of managing profitability and finding creative solutions addressing financial problems.
• Good analytical, decision making and problem-solving skills.
• A self-starter, with high energy level with strong interpersonal and communication skills.
• Strong team player with a “roll up your sleeves and get the job done” attitude.
• Extremely detail-oriented, efficient, and able to multitask, prioritize, manage and follow projects through to completion.
• Must have high standards of integrity, ethics, and confidentiality.
• Ability to produce quality work with accuracy, efficiency and timeliness.

Experience needed

4 years’ experience in a busy credit department in a healthcare organization or medical claims underwriting in an insurance company.

• Ensure that all insurance invoices are submitted to the payors within 7 days after an invoice was generated and 48 hours for all online submissions.
• Ensure that all insurance statements are sent to the insurance and corporate partners by the 6th of every month.
• Ensure accurate and timely submission of an aging report by 8th of every month clearing indicating the receivable days across all payors and across the overall debtors outstanding.
• Reconciliation reports for all payors should be sent to the Credit Control Manager by 15th of every month for review.
• Rejected claims reports for all signed off accounts should be shared with the Senior Manager Credit control at the end of every quarter for review and approvals.
• Prepare periodic reports on collection trends, key account performance, and credit risk analysis for the assigned accounts.
• Support internal and external audits by providing requested credit documentation and reconciliations where necessary.
• AR Reconciliation Accuracy Rate of ≥ 99.5% accuracy in matching the receivable accounts, insurer statements, and AR sub-ledger balances, with less than 0.5% material variances.
• All accounts receivables should be reconciled monthly and all due invoices not paid should be paid within the next payment cycle if they do not have any underlying issues that delays their payment.
• Ensure that the rejected claims are maintained at below 0.5% of the total outstanding during every sign off.
• Rejected claims review should be done on a monthly basis and reports of the same submitted to the Medical billing Manager for review by 15th of every month.
• Conduct quarterly sign offs for all assigned receivable accounts.
• Ensure that over 90% of all identified underpayments and non Penda reconciled items are settled claims within 45 days of identification.
• Provide technical system support on SHA billing processes in liaison with the Medical Billing Manager.
• Build and maintain strong working relationships with the Social Health Authority to support timely settlement of outstanding claims.
• Prepare and maintain monthly SHA reports for all branches, highlighting variances between the Penda EMR records and actual submissions on the SHA portal.
• Ensure timely submission of SHA revenue reports before 4th of every month.
• Follow up on collections for amounts owed to Penda by the Social Health Insurance (SHA)

• Excellent interpersonal and communication skills.
• Self-motivated with ability to work well under pressure
• Track record in achieving financial reporting deadlines.
• Capable of managing profitability and finding creative solutions addressing financial problems.
• Good analytical, decision making and problem-solving skills.
• A self-starter, with high energy level with strong interpersonal and communication skills.
• Strong team player with a “roll up your sleeves and get the job done” attitude.
• Extremely detail-oriented, efficient, and able to multitask, prioritize, manage and follow projects through to completion.
• Must have high standards of integrity, ethics, and confidentiality.
• Ability to produce quality work with accuracy, efficiency and timeliness.

• Advanced Diploma in Finance, Business Management, Insurance, or a related field, with progress toward or completion of a relevant professional certification (e.g., CPA III, ACCA, or equivalent).