Medical Doctor at Novo Health Africa

About the Role

• We are seeking a highly skilled and experienced Medical Doctor to join our team.
• The ideal candidate must have strong HMO industry experience, with proven expertise in Provider Management, Billings, and Claims.
• The role requires a detail-oriented professional who can ensure quality service delivery, effective provider engagement, and efficient management of claims and billing processes.

Key Responsibilities

• Manage and maintain strong relationships with healthcare providers to ensure quality service delivery.
• Oversee provider onboarding, contracting, performance review, and compliance with HMO standards.
• Review and evaluate medical claims, ensuring accuracy, validity, and alignment with clinical standards and tariff agreements.
• Coordinate the billing and claims process, ensuring timely adjudication and resolution of 
• Monitor utilization trends, identify fraudulent or abusive claims, and recommend corrective actions.
• Provide medical support for Pre-Authorizations, Case Management, and Utilization Review.
• Ensure adherence to regulatory guidelines, clinical best practices, and internal policies.
• Support the development and implementation of provider engagement strategies and service improvement initiatives.
• Prepare periodic reports and analytics to support decision-making.

Requirements

• MBBS or MBBCh from a recognized institution (with valid practicing license).
• Minimum of 5 years post-NYSC experience, with at least 3 years working in an HMO setting.
• Strong knowledge of HMO operations, NHIA guidelines, provider management, billing protocols, and claims adjudication.
• Excellent analytical, communication, and negotiation skills.
• High level of integrity, attention to detail, and ability to work in a fast-paced environment.
• Proficiency in MS Office and basic health management software.