HMO / NHIS Officer at St Dominic Catholic Hospital

Job Summary

• The Health Insurance Officer is responsible for managing all health insurance related activities within the hospital, including claim verification, processing, and payment reconciliation.
• They act as a key liaison between the hospital, insurance providers, and patients, ensuring accurate and timely billing and payment for services rendered.

Key Responsibilities

• Oversee the entire billing process for health insurance claims, ensuring accurate and timely submission to insurance providers (HMOs).
• Ensure proper documentation for insurance claims, including medical coding, billing codes, and patient information.
• Resolve any discrepancies or issues with rejected claims, working closely with insurance companies and healthcare

Compliance & Documentation:

• Maintain accurate records of all billing transactions, claims, and payments.
• Stay updated on changes in healthcare insurance Policies.

Customer Service & Dispute Resolution:

• Handle inquiries from insurance companies, patients, and other stakeholders regarding billing issues, claims status, and payments.
• Work closely with the patient services department to resolve any billing-related concerns, ensuring a positive patient experience.
• Resolve billing disputes and follow up on unpaid claims to ensure timely and accurate payments.
• Prepare and process medical expressions and related documents.
• Maintain accurate insurance records and ensure timely follow-ups.
• Collaborate with departments and liaise with insurance companies effectively.

Requirements

• Minimum of 2 years of relevant experience.
• Proficiency in MS Office Suite (Word, Excel, PowerPoint).
• Excellent communication, attention to detail, and organizational skills.