Vetting/Medical Claims Officer

NFT Consult Uganda is recruiting on behalf of a client that is part of the healthcare cluster of CIEL Group, a leading healthcare provider in Uganda and the region.

Position Summary

This role is critical to accurate and complete billing of services in the organization, and to the collection of payments for services rendered.

Position Details

• Department: Finance
• Reports To: Credit Control Manager

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
• Ensure the doctor's prescription matches the diagnosis, and check the completeness of 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 for 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
• Prepare a summary of rejections per insurance company, invoice number, amount and patient name
• 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 them, and attend reconciliation meetings with insurance companies
• Communicate common reasons for rejections to the responsible officers to avoid repeat errors
• Identify rejections due to negligence and refer them to the responsible officers for recovery
• Compile a daily report on work done (invoices received, vetted and rejected) per biller and per insurer
• Perform any other task assigned from time to time

Qualifications and Experience

• A good first degree or diploma in Clinical Medicine, or a good first degree or diploma with an accounting emphasis
• Good and demonstrable understanding of IMG philosophy, vision and strategy (desirable)
• Good interpersonal skills
• Good verbal and written communication skills to work effectively with clients, the team and other staff
• Good and demonstrable leadership skills (desirable)
• Computer literacy, especially MS Office
• Knowledge of and ability to use Navision (critical)
• Prior experience in a similar field is desired