MEDICAL CARE ASSESSOR (NURSE)
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.