Main Purpose of the Job- (Job Summary)

To support the claims process by preparing and verifying claim documents and assisting with patient billing issues. The role focuses on ensuring documentation is complete for timely claims submission and preventing rejections.

Key Responsibilities:

Claims Documentation & Support

• Obtain and verify pre-authorizations for insured patients before billing.
• Ensure claim forms are complete — including diagnosis, doctor’s notes/signatures, QR codes, and patient details.
• Check for consistency across patient charts, invoices, and claim attachments.

Invoice Preparation & Submission

• Generate, verify, and close accurate invoices in the billing system for cash, credit, and insurance patients.
• Match invoices to corresponding authorization codes and patient service records.
• Prepare claims for submission (physical and digital) and ensure daily dispatch logs are updated.

Reconciliation & Billing Follow-Up

• Track and follow up on claims pending due to exceeded limits, missing documentation, or rejections.
• Assist in reconciling billed amounts with insurer remittances or SHA statements.
• Log rejections and errors for trend analysis and continuous improvement reporting.

Patient & Interdepartmental Liaison

• Respond to patient billing queries with professionalism and accuracy.
• Liaise with clinical, front office, and finance teams to clarify service dates, diagnosis codes, or authorization needs.
• Alert relevant departments of billing or claim anomalies requiring correction.

Data Management & Compliance

• File and organize claim documents in line with internal filing protocols (digital and physical).
• Ensure compliance with patient data privacy laws (e.g., Data Protection Act, 2019).
• Update claim and invoice trackers to support real-time reporting.

Reporting & Administrative Support

• Generate basic reports on daily claims submitted, claims pending, and invoice status.
• Assist in updating SOP manuals or process checklists as needed.
• Support preparation for internal audits or insurer reviews by locating and compiling required documentation.

Continuous Learning & Systems Use

• Stay updated on SHA and private insurer billing requirements.
• Participate in internal training on claims, invoicing, and accounting systems.
• Contribute ideas for improving claims turnaround and documentation accuracy.

Support the revenue cycle team with ad hoc tasks aligned with the role’s scope.

Any other duties as may be assigned by the supervisor

Key Deliverables of this position

• 100% accuracy and completeness of insurance and credit documentation before delivery of service.
• Reduction in claim rejections through proactive documentation checks and SOP compliance.
• Effective coordination across departments to ensure timely claims submission and revenue assurance.

Essential

• Diploma in Accounts, Business Administration, Health Records, , or a related field.

Desirable

• CPA training is desirable

Work Experience & Skills

Essential

• Minimum 1-2 years of experience in a medical billing/revenue cycle role, preferably in a hospital or insurance setting.

Desirable

• Knowledge of medical insurance procedures in Kenya (including SHA/SHIF, private insurance payers, etc.).

Key Competencies

Essential

• Knowledge of medical billing software and EMR systems
• Strong attention to detail and accuracy
• Problem-solving and critical thinking abilities
• Excellent communication and interpersonal skills

Desirable

• Ability to work in a fast-paced environment and under pressure