HMO (Billing) Officer at Zael Business Management and Consulting

Responsibilities

• Manage the hospital's Health Maintenance Organization (HMO) relationships, including processing claims, verifying eligibility, and coordinating payments.
• Ensure accurate and timely billing of medical services provided to patients, including inpatient, outpatient, and ancillary services.
• Verify insurance coverage and benefits for patients, obtaining pre-authorizations and referrals as necessary.
• Review medical records and documentation to ensure compliance with billing regulations and coding guidelines.
• Generate and submit insurance claims electronically or via paper submission, following up on outstanding claims and denials as needed.
• Respond to inquiries from patients, insurance companies, and government agencies regarding billing and insurance-related matters.

requirements

• Education: A Bachelor's Degree in Healthcare Administration, Business Administration, Finance, or a related field is typically required. Some positions may prefer candidates with a master's degree or relevant certifications.
• Experience: Previous experience in healthcare administration, insurance coordination, or HMO management is highly desirable. Candidates should ideally have 1-3 years of experience in a similar role within a healthcare setting.
• Knowledge of HMO Operations: Strong understanding of HMO operations, including claims processing, eligibility verification, pre-authorizations, and coordination of benefits.