HMO / Billing Officer at JoyBridge HR Solutions

• Our client is looking for a HMO/Billing Officer who will be responsible for managing all activities related to Health Maintenance Organizations (HMOs), private billing, and corporate account transactions.

HMO & Insurance Management:

• Register and verify patient HMO eligibility and benefits before service delivery.
• Liaise with HMO representatives for approvals, service codes, and pre-authorizations.
• Track, document, and manage all HMO-related treatments, investigations, and referrals.
• Ensure that all HMO claims are submitted accurately and on time.

Billing Operations:

• Prepare and issue invoices for HMO, private, and corporate clients.
• Accurately capture all billable services and consumables used by patients.
• Monitor and reconcile daily patient bills and revenue against services rendered.
• Identify and correct billing discrepancies before submission.

Claims Management:

• Compile, validate, and submit claims to HMOs and corporate clients promptly.
• Track the status of submitted claims and follow up on pending or rejected ones.
• Resubmit or rectify rejected claims with supporting documentation.
• Maintain proper documentation for all claims for audit and review purposes.

Payment Reconciliation:

• Reconcile payments received with claims submitted to ensure completeness and accuracy.
• Work closely with the finance team to ensure timely posting of payments and resolution of variances.
• Prepare periodic aging reports and outstanding claims summaries for management.

Reporting & Documentation:

• Maintain accurate records of patient accounts, invoices, HMO approvals, and payment remittances.
• Generate daily, weekly, and monthly billing and payment reports.
• Flag issues of non-payment or delayed remittances to the appropriate authority.
• Support audits by providing relevant billing documentation and reconciliations.

Relationship Management:

• Serve as the point of contact for all HMO-related inquiries and correspondence.
• Foster strong professional relationships with HMO and corporate account officers.
• Address complaints or issues from patients and clients related to billing.

Interested and qualified candidates should send their CV to: joybridgehrsolutions@gmail.com using the Job Title as the subject of the email.