Vetting/Medical Claims Officer
Full time @NFT Consult Uganda posted 38 minutes ago in Human Resource Shortlist Email JobJob Detail
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Job ID 25553
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Career Level Officer
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Experience 3 Years
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Gender Both
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Industry Human Resource
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Qualifications Degree Bachelor
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Job Type Full time
Job Description
Job Description
Department: Finance
Position: Vetting/Medical Claims Officer
Reports to: Credit Control Manager
Client Summary:
Our Client is part of the healthcare cluster of CIEL Group, and is a leading healthcare provider in Uganda and the region, delivering the most caring medical expertise, always putting our patients first.
Position Summary:
This job is critical to accurate and complete billing of services in the organization; and the collection of payments for services rendered.
Duties and Responsibilities:
- Review all medical and non-medical errors on each claim.
- Ensure that all sections of all insurance claim forms are completed with no omissions.
- Ensuring the doctor’s prescription matches the diagnosis and completeness of their signatures.
- Ensure that all IPD and theatre claims/invoices are submitted with guarantees of payment attached.
- Ensure that all Un-smarted claims are submitted with an off-smart authorization attached.
- Ensure that all monthly claims of all insurance companies and corporates are fully submitted by the 2nd of every month.
- Ensure that the invoiced/submitted amount per insurer matches the final reported system amount per month
- Obtain remittance advice per insurer every month specifying paid amounts and rejected amounts per bill.
- Make a summary of rejections per insurance company, invoice number, amounts, and patient names.
- Classify all rejections into major reasons for rejection.
- Identify justifications for medical rejections and correct errors on non-medical claims.
- Identify reclaimable bills per insurer, re-submit, and attend reconciliation meetings with insurance companies.
- Communicate common reasons for rejections with the responsible officers to avoid a repeat of the same.
- Identify rejections due to negligence and attach to responsible officers for recovery
- Compile a daily report on work done (invoices received, vetted and rejected) per biller and per insurer
- Any other task that may be assigned to you from time to time
Qualifications and Experience:
- A good first degree/diploma in clinical medicine.
- Good and demonstrable understanding of IMG Philosophy, Vision and strategy (desirable)
- Good interpersonal skills.
- Good communication skills (Verbal & Written) to communicate effectively with clients, the team and other staff.
- Good and demonstrable leadership skills (desirable)
- Computer Literacy especially MS Office
- Knowledge and ability to use Navision. (critical)
- A good first degree or diploma with an accounting emphasis
- Experience in a similar field is desired.
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- Read the Job description attached.
- Apply using the Instructions Provided.
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