Care Manager at

3 weeks ago

Nairobi, Nairobi Area, Kenya Avenue Healthcare Full time

Avenue Hospital was founded in 1995 for the purpose of managing the outpatient department at the Hospital, and to extend medical services to corporate clientele through an innovative concept of Managed Healthcare.

Job Objective/Purpose

Ensure efficient and cost effective patient services as the case manager in liaison with third party payers, and ensure accurate and complete billing of patient services in accordance with the Hospital's policies and procedures.

Key Responsibilities

Conducts daily inpatient rounds of the specific schemebeneficiaries admitted in the hospital while ensuring timelyand appropriate admission, diagnosis, and care of patientsand advise the hospital and the corporate accordingly.

Ensure only authentic pre-authorizations are issued forclients seeking medical services in collaboration with theclinical team.
Draw monthly reports for specific corporate clients inclusiveof trends, analysis, market intelligence for improvedbusiness development.

Liaise daily with other concerned units especially creditcontrol and clinical department to seek amicable solutions toproblems related to our billing and invoicing system.

Respond to inquiries concerning billing activities frompatients, insurance companies, consultants or colleagues ina professional and efficient manner.

Conduct a regular review of the case process to identify gapsto enhance profitability as well as efficiency andeffectiveness in the case management process.

Enhance customer experience – establish and maintain goodrelationships with external and internal stakeholders such asunderwriter's, brokers, agents, and policy holders.

Conduct review of patients' billing statements and alldischarged patients' bills for accuracy and completenessprior to finalization of the invoices.

Provide billing information by collecting, analyzing, andsummarizing third-party billings, accounts pending, andlate charges data and trends.
Prepare billing statements for insurance companies,patients and other third parties.
Participate in audits, service evaluations and processreviews to enhance the delivery of billing service tocustomers/stakeholders.

Ensure that Avenue Healthcare corporate governancepolicies are adhered to, including preventing, detecting,and reporting any fraud or criminal activities, andImplementing audit recommendations.

Ensure adequate knowledge of, and compliance to allAvenue Healthcare policies, procedures, and systems,especially policies pertaining to the provision of medicalservices and finance.

Personal Specifications

Diploma in Nursing (KRCHN) and a valid Nursing License from NCK
Finance, Accounting or Insurance Professional qualification
Minimum of - 4 years' experience in a similar role
Customer focus and results oriented
Strong interpersonal skills, team playing abilities, and communication skills.
Highly responsive, ethical and responsible

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