KEY RESPONSIBILITIES

VETTING

• Ensure patients are covered for services being offered through checking fingerprints, card validity, and card ownership.
• Ensures patients are treated within their limits of cover
• Ensures that we do not treat expired/ineligible members.

PRE-AUTH SEEKING

• Ensure to seek authorization for procedures, admission, ambulance pickups/drops before the service is provided or given to the patient.
• Ensures documented authorizations from all insurance partners through emails or handwritten letters.
• Responsible for attaching approvals on claims before submission to the claims office in Accounts.

CUSTOMER SERVICE/CARE

• Insurance Billing Officer has the responsibility of ensuring that insurance patients are well received, are given all the necessary information relating to their treatment, cover, and are smoothly taken through the system (hospital) with minimum setbacks.
• Ensuring good customer care by all the team members

BILLING/SMARTING/TRACKSOLING

• All claims are to be billed using the different billing systems i.e., Tracksol, Smart, AAR, Sancare, etc.
• For all claims billed off system, a reimbursement should be sent and the authorizing person indicated.

CHECKING CLAIM FORMS

• One has to go through the claim forms and see if they were properly billed and if they were fully filled and finalized as follows:
• Claims date
• Employee company/employer
• Employee name
• Patient phone number
• Diagnosis
• Key symptoms
• Proof of authorizations attached
• Services itemized and each billed individually
• Claims billed
• Signature: Patient & Doctor

PREPARATION OF CLAIM FORMS

• All claim forms must be posted and excelled for proper record keeping and reconciling.

OTHERS RESPONSIBILITIES

• To always make sure that the Insurance Billing workstations are kept clean and tidy.
• Always account for equipment received from the Head of Department.
• Attend all Insurance Billing team meetings as may be communicated by the head/supervisors.
• Any other duties as may be assigned by the supervisors.

KEY RESULT AREAS

• Accurate billing in HMIS Systems, SMART & claim forms
• Ability to meet timelines and deadlines
• Claims tracking & accountability
• Process compliance
• Pre-authorization

EDUCATION, EXPERIENCE & COMPETENCIES

• Minimum of Diploma in Clinical Medicine, Nursing from a recognized OR Bachelor’s Degree in Business Administration or related courses from a recognized institution
• Minimum of 2 years’ experience as an Insurance Billing Officer or in a similar role
• Written and oral communication
• Proficiency in MS Office
• Good Interpersonal skills
• Good Customer care skills
• Observant and detail oriented
• Ability to work under pressure
• Relationship management