Claims and Billing Officer at Nairobi Adventist Hospital

Job Purpose

The main purpose of the job is to provide correct billing for patients under cash, private insurances and SHA/SHIF cover in an accurate and timely manner.

Key duties and responsibilities

• Prepare billing statements for insurance companies, cash and corporate patients and other third parties
• Review the discharge sheets for accuracy and completion to prepare billing statements
• Analyze invoices and data, prepare reports and respond to inquiries concerning billing activities
• Ensure pre-authorizations are done for corporate and SHIF clients
• Verify SHIF status and approvals and ensure biometrics capture as per procedure
• Update patients’ bills daily in coordination with other billing points within the hospital and other external partners
• Ensure that all services offered are billed/invoiced
• Update the corporate and cash payers on their bills daily or on-demand
• Carry out daily routine ward rounds to collect billing information and update the clients and patients
• Check insurance/corporate/SHIF documents for authenticity and validity
• Establish payment arrangements with patients; monitor payments; following up with patients when payment lapses occur
• Discharge clients by processing their bills and issuing gate passes
• Prepare daily, weekly and monthly billing reports
• Post/process bills in the correct and relevant accounts in the system
• Prepare the physical corporate SHIF invoices-claims and attach the relevant documents for dispatch within the agreed credit period
• Participate in stock take exercises
• Ensure safe custody of all documents/LOUs /Guarantee of Payments used in discharging Corporate clients
• Serve and protect the hospital’s image by adhering to professional standards, hospital policies and procedures
• Any other responsibility assigned to the jobholder by the supervisor from time to time
• Follow up with insurance companies, SHIF and other corporate players for timely payment of claims
• ETIMS: entering all corporate invoices in ETIMS, generating all receipts and filling them according to receipt number
• Any other relevant roles as may be assigned by the administration

Qualifications

Educational Qualifications

Diploma or Bachelor’s Degree in:

• Accounting, Finance, Business Administration, Health Records and Information Management
• Any other related fieldCPA (Certified Public Accountant) – at least CPA Part I or IIACCA (Association of Chartered Certified Accountants)CHRP (Certified Healthcare Revenue Professional)
• At least 4 years of experience in hospital billing, medical claims processing, or healthcare finance.Experience with SHIF and private insurance claims.Knowledge of hospital billing software and accounting systems.Strong knowledge of hospital billing procedures and insurance claims processing.
• Familiarity with SHIF and private insurance policies.
• Proficiency in Microsoft Office and hospital billing software.
• Excellent analytical and numerical skills.
• Strong communication and customer service skills.
• Ability to work under pressure and meet deadlines

Competencies

• Computer literacy,
• Accounting skills
• Attention to detail
• Customer relation skills
• Communication skills
• Negotiating skills