Admissions & Discharges Office – Team Lead at Valley Hospital

key Responsibilities

Insurance/corporate Pre-authorisation & Authorization Management

• Oversee and review all outpatient pre-authorisation requests submitted to insurance/corporate companies including Social Health Authority (SHA), ensuring accuracy, completeness, and timeliness
• Supervise the end-to-end inpatient authorization process from initial submission through to approval, including management of pending cases and escalation of disputes
• Maintain up-to-date knowledge of payer policies, SHA protocols, and benefit schedules to guide the team on correct claim coding and authorization submission
• Monitor authorization turnaround times and flag delays that may affect patient care or revenue flow, escalating to clinical or finance teams as needed
• Liaise directly with insurance/corporate case managers/contacts and SHA relationship officers to resolve disputes, obtain extensions, and manage complex or high-cost authorizations

 Admissions Management

• Supervise the admission of all referred patients from external healthcare facilities, ensuring proper documentation, clinical handover protocols, and bed allocation are coordinated promptly
• Manage the conversion process for outpatients requiring inpatient admission, ensuring a seamless transition without disruption to the patient experience or clinical workflow
• Verify completeness of all admission documentation including referral letters, patient identification, insurance/corporate eligibility checks, and deposit or guarantee letters where applicable
• Coordinate with clinical departments, nursing, and housekeeping to manage bed availability and expected admissions, minimizing patient waiting times
• Ensure all admissions are captured accurately and in real time on the Hospital Management Information System (HMIS)

Discharge Coordination

• Oversee the discharge process to ensure timely clearance of patients, including final billing reconciliation, insurance/corporate sign-off, and collection of outstanding patient balances
• Coordinate with nursing, pharmacy, and finance teams to resolve pre-discharge holds and confirm discharge summaries are complete before patient departure
• Monitor average length-of-stay data and work with clinical teams to reduce avoidable delays in discharge

Team Leadership & Department Oversight

• Directly supervise and performance-manage all staff within the Admissions & Discharges Office across all shifts, including weekends and public holidays
• Prepare duty rosters ensuring adequate coverage at all times; manage leave, absenteeism, and overtime within approved thresholds
• Identify training needs and facilitate on-the-job coaching and structured development to maintain team competency and service quality
• Conduct regular team briefings and performance reviews, documenting outcomes and escalating HR matters as appropriate
• Foster a culture of accuracy, accountability, and patient-centred service

Metrics, Reporting & Analytics

• Track and report on key performance indicators including pre-authorisation approval rates, denial/rejection rates, admissions volumes, OP-to-IP conversion rates, and discharge turnaround times
• Prepare daily, weekly, and monthly operational reports for the Head of Patient Services and senior management
• Identify trends and recommend operational or policy changes to improve authorization approval rates and reduce admission delays

Process Improvement & Compliance

• Implement process changes to reduce authorization errors and shorten the patient admission-to-discharge cycle
• Ensure compliance with healthcare regulations, insurance/corporate contractual obligations, SHA requirements, and internal administrative controls
• Collaborate with clinical, billing, and finance teams to close gaps at the point of patient registration, authorization, and discharge documentation

Key Competencies

• Analytical thinking and attention to detail
• Strong communication and negotiation skills
• Leadership and team development
• Process improvement orientation
• Patient-centred service mindset and understanding of healthcare operations

Requirements

• Diploma or Bachelor’s degree in Health Records & Information Management, Business Administration (Healthcare), Nursing, or a related field
• Minimum 3 years’ experience in a hospital front office, admissions, or medical billing environment.
• Proficiency in a Hospital Management Information System (HMIS); familiarity with SHA and private insurer authorization platforms
• Working knowledge of Kenya’s Social Health Insurance, private insurance/corporate framework (SHA) and insurance/corporate panel processes
• Training in medical billing or insurance/corporate claims processing is an added advantage