Key Responsibilities:

Billing and Invoicing:

• Prepare and process invoices for all hospital services, including outpatient, inpatient, pharmacy, laboratory, theatre, and diagnostic services.
• Ensure that all services provided are accurately recorded and billed.
• Generate patient bills and ensure prompt invoicing in accordance with hospital policies.

Insurance Claims Processing:

• Verify patient insurance information and coverage prior to billing. Prepare and submit claims to insurance companies, including NHIF (National Hospital Insurance Fund) and private insurance providers.
• Follow up on unpaid or rejected claims and resubmit claims as necessary.

Patient Account Management:

• Maintain accurate and up-to-date records of patient accounts, including charges, payments, and outstanding balances. Track and reconcile daily billing transactions with hospital records.
• Work with the credit control department to follow up on overdue accounts and initiate collection procedures.

Billing Inquiries and Dispute Resolution:

• Address patient inquiries and concerns regarding billing statements, charges, and payments.
• Assist patients with insurance claims and provide clear explanations of their bills.
• Investigate and resolve billing discrepancies in collaboration with the finance department and clinical teams.

NHIF and Insurance Compliance:

• Ensure compliance with NHIF processes for inpatient and outpatient services.
• Maintain knowledge of insurance policies and provider agreements for accurate billing.
• Ensure accurate billing for NHIF and private insurance claims.

Data Entry and Record Keeping:

• Input billing information into the hospital’s billing system, ensuring accuracy and completeness.
• Maintain organized and confidential patient billing records, in line with hospital policies and data protection regulations. Generate regular reports on billing activities, collections, and outstanding balances for management review.

Collaboration with Departments:

• Collaborate with admissions, finance, pharmacy, and clinical departments to ensure accurate billing of services. Coordinate with the finance team for payment allocation and reconciliations.

Revenue Assurance:

• Monitor the hospital’s revenue collection processes and recommend improvements to enhance efficiency.
• Ensure that all services provided are billed correctly to minimize revenue leakage.

Qualifications:

Education

• Diploma in Accounting, Finance, Business Administration, or a related field.
• Certification in medical billing or health information management is an added advantage.

Experience

•  At least 2-3 years of experience in a hospital or healthcare billing environment.
• Experience with NHIF and insurance billing processes in Kenya is required.

Knowledge

• Knowledge of billing, hospital revenue cycles, and insurance claims in Kenya.
• Understanding of Kenyan healthcare tax regulations.