Job Summary:

The HMO Billing Officer is responsible for coordinating all Health Maintenance Organization (HMO) billing processes, ensuring accurate claims submission, prompt payment reconciliation, and compliance with health insurance standards. She serves as the primary liaison between the hospital, patients, and HMO representatives, facilitating seamless billing, approvals, and documentation to support financial efficiency and patient satisfaction.

This role requires a detail-oriented, organized, and proactive professional with excellent communication and analytical skills, as well as a solid understanding of medical billing procedures and HMO operations.

Key Responsibilities:

HMO Billing & Claims Management

• Prepare, review, and submit HMO bills, pre-authorization forms, and claims in accordance with established guidelines and timelines.
• Verify patients’ HMO status, coverage limits, and benefits prior to treatment or service.
• Ensure proper documentation and coding of services rendered before claim submission.
• Monitor all pending and approved HMO claims to ensure timely processing and payment.

HMO Liaison & Communication

• Serve as the primary contact person for HMO representatives regarding billing inquiries, approvals, and reconciliations.
• Communicate with medical and administrative teams to ensure all procedures and services are appropriately captured for billing.
• Follow up regularly with HMO companies for claim approvals and payment updates.
• Handle patient inquiries regarding HMO coverage, approvals, and billing procedures courteously and professionally.

Reconciliation & Reporting

• Reconcile HMO payments against submitted claims and identify variances, rejections, or shortfalls.
• Maintain an up-to-date record of all HMO transactions and outstanding balances.
• Generate periodic billing reports for management review and financial planning.
• Escalate unresolved issues and delays in payment to the Head of Department or Finance Manager.

Compliance & Documentation

• Ensure all claims and documentation meet HMO, hospital, and regulatory standards.
• Maintain confidentiality of patient and financial information at all times.
• Participate in audits, billing reviews, and system improvement initiatives.

Education & Qualification

• Bachelor’s Degree or Higher National Diploma (HND) in Accounting, Business Administration, Health Information Management, or related field.
• Certification or training in HMO processes, medical billing, or health insurance management is an advantage.

Experience

• Minimum of 2–3 years of relevant experience in hospital billing, HMO liaison, or health insurance claims management.
• Proven familiarity with HMO portals, claims submission, per-authorization workflows, and reconciliation procedures.
• Experience working in a hospital, diagnostic center, or healthcare facility required.