Case Manager at Imara Mediplus Medical Centre

• Responsible for coordinating and facilitating patient care across various departments and services within the hospital. This role involves assessing patient needs, planning and managing care programmes, and working closely with healthcare professionals to optimise patient outcomes.

 KEY RESPONSIBILITIES 

• Collaborate with providers, insurance representatives, and billing staff to streamline the billing process and resolve issues.
• Accurately process and submit medical claims using correct coding.
• Review and verify patient information, insurance eligibility, and coverage.
• Submit and track claims to insurance companies and third-party payers.
• Stay up to date with changes in insurance eligibility and coverage.
• Send pre-authorisation requests for scheduled and non-scheduled admissions within set guidelines.
• Follow up on unpaid or denied claims, promptly resolving billing issues and discrepancies.
• Follow up on pre-authorisations sent to insurers and notify patients of progress.
• Update medical and progress reports for insurers.
• Liaise with doctors on the day-to-day management of patients and obtain medical reports.
• Ensure a smooth admission and discharge process for patients.
• Prepare and share daily pre-authorisation reports with insurance companies.
• Perform any other duties as assigned by the supervisor.

QUALIFICATIONS

• Degree in Nursing or a Diploma in Kenya Registered Community Nursing/Clinical Medicine.
• Diploma in Insurance.
• Minimum of three (3) years’ proven experience in a clinical setting or a busy health insurance environment, focusing on case management.

JOB SKILLS

• Strong negotiation and effective communication skills, both written and spoken
• Excellent customer service skills; a team player with the ability to collaborate across departments
• Well-networked with service providers (SPs) and other medical insurance stakeholders
• High level of accuracy and attention to detail, with strong monitoring and analytical skills
• Good interpersonal and public relations skills
• Proficient IT skills, including database management and office systems