Medical Care Assessor at Premier Hospital

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

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