Health Maintenance Organization (HMO) Officer at First Rivers Hospital Limited

Summary

• An HMO Officer manages Health Maintenance Organization (HMO) related activities for a healthcare provider, focusing on patient insurance verification, claims processing, billing, and liaising with HMO representatives to ensure accurate payments and compliance with regulations.
• Key responsibilities include verifying patient benefits, obtaining service authorizations, submitting and tracking claims, coordinating with billing departments, and resolving discrepancies to ensure timely processing of payments and services.
• The role requires strong administrative, communication, and problem-solving skills, along with accuracy and attention to detail.

Key Responsibilities
HMO Liaison:

• Act as the primary point of contact between the healthcare provider and HMOs, managing communications and building strong relationships.
• Patient Verification: Confirm patient eligibility and benefits with various HMOs to ensure they are covered for services.
• Authorization & Approvals: Obtain necessary approvals from HMOs for specific medical treatments or services.
• Claims Management: Prepare, submit, and track claims with HMOs, following up on rejected or pending claims to ensure prompt payment.
• Billing & Reconciliation: Work with the billing team to ensure accurate invoicing and reconcile HMO payments, outstanding balances, and discrepancies.
• Compliance: Ensure all HMO transactions and communications adhere to regulatory requirements and hospital policies.
• Problem Resolution: Address discrepancies and issues related to claims or coverage between patients and HMOs.
• Record Keeping: Maintain accurate and up-to-date patient records, HMO information, and relevant documentation.

Key Skills and Qualifications

• Administrative Skills:Proficiency in office software, such as MS Excel, is essential for managing data and generating reports.
• Communication Skills: Strong oral and written communication skills are necessary to interact effectively with HMO representatives and patients.
• Problem-Solving Skills: The ability to resolve issues with claims, billing, and patient coverage is crucial.
• Attention to Detail: High accuracy is required to ensure the correctness of patient information, billing, and claims.
• Organizational Skills: Multi-tasking abilities are important for managing various HMO-related tasks simultaneously.
• HMO Experience: Experience in hospital billing, HMO operations, or health insurance is highly valued.