Premier Hospital is a tertiary care facility situated in Mombasa City along Links Road in Nyali area. Since its inception in 2017, the hospital has experienced tremendous growth due to its operating philosophy which is anchored on compassion, care and competence. One of our key area of focus is customer experience. Qualified candidates are hereby invited to apply for the following exciting career opportunities.
JOB TITLE: MEDICAL CARE ASSESSOR (NURSE)
JOB LOCATION: PREMIER HOSPITAL
REPORTS TO: CREDIT MANAGER
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
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.
- 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.
- 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
Qualified and interested candidates should send their application letter and curriculum vitae to email@example.com 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.