Premier Hospital is an 82 bed specialized hospital located in Nyali, Mombasa offering high quality emergency, outpatient and inpatient care. We have a patient centered culture and our approach is to provide you with comprehensive healthcare, which is focused on all aspects of your health and overall well-being. Our service delivery model is anchored on Compassion, Care and Competence. Our Doctors, Nurses, other Medical Professionals and support staff will provide you with personal service with great regard to respect and dignity to ensure that your experience with us is as comfortable as possible.
REPORTS TO: CREDIT MANAGER
JOB SUMMARY
The Medical care assessor ensures smooth operations in all aspects of the Hospital operation.
The job entails;
- Billing guide management
- Cost containment
- Medical claims management
- Follow-up and escalation of urgent issues
- Co-ordination and daily reporting on matters
- Reconciliation and resolution of queries among others
CORE RESPONSIBILITIES
Billing guide management
- Create and implement a billing guide with checkpoints that can guide revenue officers on any under billings or over billings
- Check all bills (Inpatient and Outpatient) raised in the hospital for any mistakes during billing.
- Create relevant checklists for all wards for use by the billing team when charging patients.
- Ensure all medical insurance billing policies and procedures are adhered to
- Act as the interface between patients, doctors, and other departments regarding professional billing operations
- Keep safe custody of all passwords issued for use in the various hospital systems.
Cost containment
- Work with various teams to create appropriate hospital packages (Inpatient and Outpatient)
- Continuous review of the hospital packages ensuring they remain competitive in the market by benchmarking against similar systems
- Review capitation bills/fixed cost bills and ensure any bills that cross the stated amounts are justified
- Report daily any incidences involving bills with issues/those that have crossed the insurance limits.
- Liaise with the doctor to ensure that the appropriate length of stay is achieved.
- Cross check the branded vs generic mix and ensure that it is in line with hospital policies and the healthcare industry.
- Share a daily report on the capitation/ fixed cost bills.
- Ensure all items used on a patient are billed to prevent losses to the hospital
- Ensure real time consumption of stocks received by various departments
Medical Claims management
- Supervise and ensure all the required claim documents have been filled by patients and doctors for forwarding to insurance.
- Correct any mismatch between diagnosis and treatment on claim forms before the bill is dispatched to the insurance.
- Respond to insurance clinical queries arising from time to time.
- Supervise and ensure all the required claim documents have been filled by patients and doctors for forwarding to insurance
- Cross check all invoices to ensure completion and handover to the dispatch team daily.
Human Capital
- Ensure periodic departmental trainings are done and reports shared with Human Resource.
- Supervise and ensure excellent customer experience is delivered and maintained
- Ensure real time communication to Revenue Officers regarding matters billing from Management
REQUIREMENTS
MINIMUM REQUIREMENTS/ QUALIFICATIONS
- Diploma in Community Health Nursing
- 1 Year working in a busy Health facility
KEY JOB REQUIREMENTS
- Strong written and oral communication skills
- Strong computer skills
- Ability to work in a fast-paced and high demand environment
- Flexibility of working with many different types of people and situations
- Strong and highly visible team player with relationship building skills
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