Medical Care Assessor Job, Current Medical Jobs Kenya,



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



How To Apply



Qualified and interested candidates should send their application letter and curriculum vitae to careers@premierhospital.org clearly indicating on the email subject the position being applied for. The application should be received not later than 5.00pm on Wednesday 20th October 2021. Only short-listed candidates will be contacted.



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