HMO Relationship Officer at Tranquil & Quest Medical and Diagnostics Limited

Job Summary:

• The HMO Relationship Officer is responsible for managing and nurturing relationships between the hospital and Health Maintenance Organizations (HMOs). This role ensures prompt processing of approvals, accurate billing, timely reconciliation, and excellent service delivery to enrollees under various HMOs. The officer serves as the key liaison between internal departments, patients, and HMO providers.

Key Responsibilities:

• Act as the primary contact person between the hospital and all partnering HMOs.
• Process and follow up on pre-authorizations, approvals, and codes for consultations, procedures, and admissions.
• Ensure proper documentation and accurate billing of all HMO-related transactions.
• Monitor and track pending claims, approvals, and denials, ensuring timely resolution.
• Liaise with clinical departments and consultants to ensure treatments covered under HMOs are properly routed and documented.
• Coordinate regular reconciliations with HMO providers and internal billing/accounting teams.
• Ensure timely submission of claims and follow up on payments or rejections.
• Respond to enquiries, complaints, or disputes from HMO representatives and enrollees in a professional manner.
• Maintain updated knowledge of HMO plans, policies, tariffs, and agreements.
• Provide monthly reports on HMO performance, claim status, and revenue.
• Assist in negotiating and reviewing HMO contracts and terms.
• Promote excellent service delivery for patients under HMO coverage.

Qualifications & Skills:

• Bachelor’s Degree in Health Administration, Business Administration, Accounting, or a related field.
• Minimum of 2-3 years of relevant experience, preferably in a healthcare/HMO-facing role.
• Strong understanding of the Nigerian healthcare and health insurance system.
• Excellent interpersonal and negotiation skills.
• Attention to detail, with strong analytical and reconciliation abilities.
• Proficiency in Microsoft Office tools and basic knowledge of hospital billing systems.
• Ability to work under pressure and manage multiple HMO accounts simultaneously.
• Strong communication and documentation skills.