About the job
HMO & Insurance Management
Register and verify patient HMO eligibility and benefits before service delivery.
Liaise with HMO representatives for approvals, service codes, and pre-authorizations.
Track, document, and manage all HMO-related treatments, investigations, and referrals.
Ensure that all HMO claims are submitted accurately and on time.
Billing Operations
Prepare and issue invoices for HMO, private, and corporate clients.
Accurately capture all billable services and consumables used by patients.
Monitor and reconcile daily patient bills and revenue against services rendered.
Identify and correct billing discrepancies before submission.
Claims Management
Compile, validate, and submit claims to HMOs and corporate clients promptly.
Track the status of submitted claims and follow up on pending or rejected ones.
Resubmit or rectify rejected claims with supporting documentation.
Maintain proper documentation for all claims for audit and review purposes.
Payment Reconciliation
Reconcile payments received with claims submitted to ensure completeness and accuracy.
Work closely with the finance team to ensure timely posting of payments and resolution of variances.
Prepare periodic aging reports and outstanding claims summaries for management.
Reporting & Documentation
Maintain accurate records of patient accounts, invoices, HMO approvals, and payment remittances.
Generate daily, weekly, and monthly billing and payment reports.
Flag issues of non-payment or delayed remittances to the appropriate authority.
Support audits by providing relevant billing documentation and reconciliations.
Relationship Management
Serve as the point of contact for all HMO-related inquiries and correspondence.
Foster strong professional relationships with HMO and corporate account officers.
Address complaints or issues from patients and clients related to billing.
Requirements
Bachelor's Degree or HND in Accounting, Finance, Business Administration, or related fields.
0-2 years minimum experience in HMO/Billing Officer role.
Knowledge of HMO operations, health insurance codes, and billing procedures is an added advantage.
Excellent proficiency in Microsoft Excel and EMR platforms.
Strong attention to detail and ability to multitask.
Good communication and interpersonal skills.
Willingness to work on a shift basis.