BILLING OFFICER

JOB TITLE:BILLING OFFICER

NATURE OF JOB: FULL TIME

INDUSTRY: HOSPITAL

SALARY:KSHS. 50,000-60,000

JOB LOCATION:EMBU

DUTIES AND RESPONSIBILITIES

Patient Billing &  Invoicing

• Generate accurate invoices for all patient services including consultation, lab tests, imaging, surgery, medication, and ward charges.
• Confirm patient insurance status and coverage before billing.
• Work closely with reception, nursing, pharmacy, and clinical departments to ensure all billable services are captured correctly in the hospital management system.

Claims Management (NHIF/SHA/Private Insurers)

• Prepare and submit claims to NHIF, SHA, and insurance companies in the prescribed formats and timelines.
• Verify patient eligibility and benefits before submission of claims.
• Attach all necessary documentation, including patient records, prescription notes, treatment summaries, and consent forms, to claims.

Reconciliation and Follow-up

• Track submitted claims and ensure timely payment.
• Investigate and resolve unpaid, denied, or rejected claims by liaising with insurers, NHIF/SHA, and internal departments.
• Reconcile remittances received from NHIF/SHA/insurance against submitted claims to identify variances.

Patient and Insurer Liaison

• Respond to patient inquiries regarding billing, insurance coverage, and outstanding balances.
• Communicate with insurance providers and NHIF/SHA offices to resolve claim discrepancies.
• Provide preauthorization support where required for procedures or admissions.

Reporting and Documentation

• Prepare daily, weekly, and monthly billing and collection reports for hospital management.
• Maintain comprehensive and organized billing records in accordance with hospital and regulatory requirements.
• Assist in audits by providing billing records and explanations as needed.

Compliance and Quality Assurance

• Ensure billing practices comply with hospital policies, NHIF/SHA regulations, and insurance agreements.
• Regularly update knowledge on NHIF/SHA changes and ensure hospital billing aligns with the latest policies.
• Identify and report any fraudulent or irregular billing activity.

KEY REQUIREMENT SKILLS AND QUALIFICATION

• Diploma or Bachelor’s Degree in Accounting, Finance, Business Administration,
• Health Records and Information, or a related field
• Minimum 2–3 years of working experience in hospital billing or in a health insurance company, specifically handling NHIF and insurance claims
• Proficient in using hospital management systems (e.g. Smart HIMS, AfyaPro, Med360, etc.)
• Deep understanding of Kenya’s health insurance landscape, including NHIF, SHA,
• and private insurers
• Knowledge of medical terminology, procedures, and diagnosis codes (ICD-10) is a strong advantage