Quality Assurance Officer at Cedarcrest Hospitals

The Role

• Vetting all HMO invoices for proper diagnosis, treatment and services.
• Routine reconciliation of outstanding bills with corporate organizations under Health Maintenance Organization (HMO) contractual agreement.
• Managing chronic disease register.
• Liaising with clinicians on care for HMO and corporate patients
• Liaising with HMO and corporate organizations on patient care

Responsibilities

• Effective monitoring to ensure that HMO’s patients access care that are within their insurance coverage.
• Ensuring that treatments and patients’ case notes are properly documented.
• Monthly and yearly reconciliation of outstanding bills with corporate organizations.
• Examine patients’ case notes to verify the treatments that they are able to access.
• Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to patients/clients/corporate organizations.
• Ensure and maintain accurate documentations for all HMO patients/clients.
• Respond to all HMO patients’/clients’ inquiries and handle complaints accordingly.
• Interface with corporate organizations via correspondences, emails and physical negotiations.

Qualifications

• MBBS
• 2+ years proven work experience as a HMO medical officer or similar role
• Familiarity with office machines (e.g. fax, printer etc.)
• Knowledge of administrative procedures
• Proficient in English (oral and written)
• Excellent knowledge of MS Office (especially Excel and Word)
• Strong communication and people skills
• Good organizational and multi-tasking abilities
• Problem-solving skills
• Customer service orientation.

Special Conditions

• Employment is contingent on passing a medical screening conducted by the hospital
• The employee will be subject to various testing including but not limited to drug and medical testing throughout the tenure of their employment.