Department: Finance

Position: Vetting/Medical Claims Officer

Reports to: Credit Control Manager

Client Brief

Our Client is part of the healthcare cluster of CIEL Group, and is a leading healthcare provider in Uganda and the region, delivering the most caring medical expertise, always putting our patients first.

Job Brief

This job is critical to accurate and complete billing of services in the organization; and the collection of payments for services rendered.

Duties and Responsibilities

• Review all medical and non-medical errors on each claim.
• Ensure that all sections of all insurance claim forms are completed with no omissions.
• Ensuring the doctor’s prescription matches the diagnosis and completeness of their signatures.
• Ensure that all IPD and theatre claims/invoices are submitted with guarantees of payment attached.
• Ensure that all Un-smarted claims are submitted with an off-smart authorization attached.
• Ensure that all monthly claims of all insurance companies and corporates are fully submitted by the 2nd of every month.
• Ensure that the invoiced/submitted amount per insurer matches the final reported system amount per month
• Obtain remittance advice per insurer every month specifying paid amounts and rejected amounts per bill.
• Make a summary of rejections per insurance company, invoice number, amounts, and patient names.
• Classify all rejections into major reasons for rejection.
• Identify justifications for medical rejections and correct errors on non-medical claims.
• Identify reclaimable bills per insurer, re-submit, and attend reconciliation meetings with insurance companies.
• Communicate common reasons for rejections with the responsible officers to avoid a repeat of the same.
• Identify rejections due to negligence and attach to responsible officers for recovery
• Compile a daily report on work done (invoices received, vetted and rejected) per biller and per insurer
• Any other task that may be assigned to you from time to time

Qualifications and Experience

• A good first degree/diploma in clinical medicine.

• Good and demonstrable understanding of IMG Philosophy, Vision and strategy (desirable)
• Good interpersonal skills.
• Good communication skills (Verbal & Written) to communicate effectively with clients, the team and other staff.
• Good and demonstrable leadership skills (desirable)
• Computer Literacy especially MS Office
• Knowledge and ability to use Navision. (critical)
• A good first degree or diploma with an accounting emphasis
• Experience in a similar field is desired.