3 weeks ago
CLAIMS/BILLING OFFICER CLERK
GILGIL SPECIALIST HOSPITAL(GSH) LTD
Accounting, Auditing & Finance
Healthcare
Confidential
Easy Apply
Job Summary
Reporting to the Facility Administrator, the position holder is responsible for managing and processing claims related to credit patient services. This includes verifying insurance coverage, preparing and submitting accurate claims to insurance providers and health schemes, following up on claim approvals, and resolving any discrepancies or denials. The role ensures timely reimbursement and plays a key part in maintaining the financial health of the company.
- Minimum Qualification : Diploma
- Experience Level : Entry level
- Experience Length : 1 year
Job Description/Requirements
Key Responsibilities
Claims Processing and Submission
Review and verify patient records, invoices, and supporting documentation for insurance claims.
Analyze invoices and data, prepare reports and respond to inquiries concerning billing activities.
Prepare billing statements for insurance companies, health schemes, cash and corporate patients and other third parties.
Review the claim forms for accuracy and completion to prepare billing statements.
Ensure claims are accurately coded (ICD, CPT, or relevant codes) and submitted to insurers or national health schemes.
Submit claims electronically or manually, in accordance with insurer requirements and deadlines.
Ensure completeness, accuracy, and compliance with relevant Service Level Agreements to avoid claims rejection.
Revenue Recognition and billing
Ensure compliance with patient insurance coverage, benefits eligibility, and co-payment requirements in the billing process.
Obtain necessary pre-authorizations and approvals from insurance companies where applicable prior to patient admission or procedures.
Ensure that all services offered are billed/invoiced.
Communicate clearly with patients about what is and isn’t covered by their insurance.
Update patients’ bills daily in coordination with other billing points within the clinic and other external partners.
Update the corporate and cash payers on their bills daily or on demand.
Check insurance/corporate/ documents for authenticity and validity.
Establish payment arrangements with patients; monitor payments; following up with patients when payment lapses occur.
Claims Follow-Up, Reconciliation and reporting
Track the status of submitted claims to ensure timely processing and payment.
Follow up on delayed, rejected, or denied claims and take corrective action as needed.
Liaise with insurers and third-party payers to resolve claim disputes or discrepancies.
Reconcile claim payments with accounts receivable and patient billing records.
Prepare daily, weekly and monthly billing reports.
Post/process bills in the correct and relevant accounts in the system.
Prepare the physical invoices claims and attach the relevant documents for dispatch within the agreed credit period.
Ensure safe custody of all documents/LOUs /Guarantee of Payments used in discharging corporate clients.
Serve and protect the company’s image by adhering to professional standards, hospital policies and procedures.
Team Collaboration
Participate in multidisciplinary team meetings to discuss effective and efficient processes to ensure 100% bills are paid including any complaints received and closure.
Participate in stock take exercises.
Participate in the monthly staff meetings including any team building activities.
Contribute to the development and implementation of all SOPs required for the section are in place, are understood by staff in the sections and are implemented consistently.
Identify areas for service improvement and make recommendations to the Clinic lead.
Continuous learning
Stay updated on the latest advancements in accounting and claims management through continuing education and professional development activities.
Supervise, mentor and develop junior staff and trainees, ensuring that their performance meets
Academic qualifications
Degree or Diploma in Business Administration, Economics, Finance or other business-related fields from a recognized institution.
Accounting qualification, i.e. Part II or ACCA 2.
At least One (1) year experience in accounting.
Copy of national identification document(ID/Passport)
Skills & competencies required:
Proficiency in computer skills (especially Health Management Information Systems).
Keen of details and accuracy,
Ability to work with hospital billing systems,
Proficient computer skills for data entry, analysis, and report generation.
Good interpersonal and communication skills for effective collaboration with the medical team and patient interaction.
Excellent attention to detail and ability to work with precision.
Ability to work in a hospital environment, multitask, and prioritize workload.
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