The Claims Processing Officer at M.P. Shah Hospital plays a critical role in ensuring the accuracy and efficiency of the hospital's billing and claims cycle. This position is responsible for managing both in-patient and out-patient invoices with a high degree of professionalism, ensuring that all services provided are accurately reflected and that documentation is complete to minimize rejection rates and maintain productive corporate client relationships.
Duties and Responsibilities
Claims Management: Manage all in-patient and out-patient invoices to ensure they provide an accurate reflection of services. Ensure minimal rejection rates by delivering complete documentation physically or online as per client policies.
Discrepancy Resolution: Work on all claim rejections within 5 working days from receipt and review dispatch documents to highlight and resolve discrepancies.
Records Maintenance: Follow up on incomplete documents at the dispatch department to maintain the validity and accuracy of hospital records.
Client Engagement: Promptly deliver claims to corporate clients and resolve all queries efficiently to promote client satisfaction.
Accountability: Maintain integrity and confidentiality while assisting in the retrieval of proof of deliveries within the set compliance framework.
Reporting: Prepare and submit necessary reports to relevant parties on time according to agreed timelines.
Development: Actively participate in personal and team development through continuous learning, sharing insights, and engaging with management for performance feedback.
Key Performance Indicators
Dispatch Turnaround Time (TAT): Inpatient (24 hours) and Outpatient (48 hours).
Rejection rate: Maintain below 1%.
Compliance: 100% adherence to Invoice Vetting SOPs.
Timeliness: 100% of invoices received within 24 hours.
Requirements and Qualifications
Education: Diploma or Higher Diploma in a business-related field.
Experience: Experience in a Finance and/or accounting position is required.
Knowledge: Accounting knowledge is considered an added advantage.
Skills: Proficiency in Microsoft Office, high attention to detail, and excellent written/verbal communication skills.
Attributes: Passion for results, strong problem-solving and analytical skills, and the ability to be a strong team player.
Interested and qualified candidates should apply online through the M.P. Shah Hospital recruitment portal via https://www.myjobmag.co.ke/apply-now/1221452 or directly at mpshahhosp.org.
