Hospital Billing Clerk

Job Purpose:

The primary responsibility is to handle the billing and invoicing procedures associated with patient services.

Key Responsibilities:

1. Bill Tracking and Claims Finalization
   

• Ensure daily realtime updates of all inpatient services to ensure that all bills are accurate and that all charges have been posted to the system at any one point in time to ensure reliable interim and final IP bills.
  

• Ensure all the required information is confirmed/obtained at the point of admitting a patient and throughout their stay.
  

• Close patient bills at discharge and ensure all required documents are attached to the inpatient bill before dispatch to the Finance Claims Office.
  

• Ensure all complete invoices and claims from the Outpatient Clinic for NHIF and all Inpatient bills are scanned and hard copies dispatched to the Finance Claims Office as per the SOPs within 24 hours of bill closure.
  

1. Internal Dispatches Documentation
   

• Ensure all IDS (Internal Dispatch Summary Reports) are acknowledged via signing and a copy scanned and emailed to the Finance Claims Office for all bills dispatched internally.
  

1. Collectable Claims Processing
   

• Ensure completeness and accuracy of claims and invoices (ensuring preauthorization or LOU signed by the doctor and client claim and bill presence of diagnosis and clear case notes and discharge summary membership/policy number claims is within the limit) and presence of smart reports where applicable.
  

1. Reports
   

• Maintain a file of the IP checklists.
  

• Sending daily status reports of all corporate and cash IPs to credit control.
  

• Sending daily status reports to corporates and insurance escalating any situation where patient LOU/PreAuth limit is likely to be exceeded within the next 24 hours to request for increase/top up in limit or if not engage patient on cash payment to top up.
  

• Weekly report on finalized invoices forwarded to Finance Claims and Credit Control and written in the control book.
  

1. Timely and Professional Discharge of IP and Day Cases
   

• Ensuring the discharge procedure authorization and billing closing procedures are followed and appropriate approval and signoff is obtained.
  

• Ensuring all Inpatient bill and NHIF Outpatient bills are properly closed in the system before submission to the Finance Claims Office.
  

• Ensure complete claims processing documents and bills are sent to the Finance Claims Office within 24 hours of patient discharge or receipt from OP for NHIF OP bills.
  

1. Ensure adherence to the laid down SOPs in IP Claims management.
   

2. Ensuring that all the insurance company requirements are met before claims are submitted.
   

Requirements

• Degree or Diploma in Finance Accounting or a related field.
  

• CPA 2 and above
  

• 3 years of experience in health care billing.
  

• Excellent attention to detail and accuracy in data entry and documentation.
  

• Effective communication skills and the ability to interact professionally with patients colleagues and insurance representatives.
  

• Ability to prioritize tasks manage time efficiently and work independently with minimal supervision.
  

• Must have strong work ethics