Medical Officer - Claims & Quality Assurance Manager at Ascentech Services Limited

Our client, a leading Health Maintenance Organisation (HMO), is currently looking to hire a Medical Officer with HMO experience, who will function in the position as Medical Officer - Claims & Quality Assurance Manager.
                                                

Duties / Responsibilities:

• Claims vetting and approval, preparation of payment claims and performing medical audit regularly
• Inspection of primary and secondary healthcare providers to guarantee they maintain set guidelines and standards as deemed acceptable.
• Inspection and register new providers, and ensuring providers adhere to respective agreements.
• Ensure best practices are adhered to in quality of care administrated to clients.
• Monitor mode and manner of medical care rendered by providers.
• Medical verification of bills to ensure adequate treatment.
• Ensure prompt and appropriate referrals; participation in medical outreach, wellness and health seminars.
• Develop and monitor quality assurance measures and preparation of regular utilization reports.
• Participate in provider forum and provision of prompt support to the Call Centre.

Essential Requirements:

Education and Experience: 

• Minimum of MBBS. Additional qualification(s) will be an added advantage.
• Minimum of 2 year experience in general medicine.  
• Minimum of 3 years’ experience in similar position in an Health Maintenance Organisation (HMO).
• Must be conversant with NHIS policy guidelines.
• Good knowledge of operational software and Microsoft office. 
• Good mentoring & motivational skills.