ASSOCIATE/ENTITLEMENT OFFICER,DEBTORS DEPARTMENT

Position Summary

Reporting to the Supervisor - Corporate Entitlement, the Entitlement Officer will assist the supervisor in the management of billing corporate guidelines (entitlements) by ensuring correct and accurate mapping in the system.  Claims vetting before dispatch and analysis of rejected claims to minimize the level of bad debts.

Key Responsibilities: 

• To offer prompt and satisfactory services to internal and external clients as per the established policies and procedures of the department to enable overall accomplishment of the departmental goals
• Participate in ensuring that all the billing points are updated on new / closed accounts, corporate clients’ administration guidelines on timely basis and they adhere to the same
• Opening/closing of accounts as advised by relevant corporate clients and in line with the hospital guidelines on the same
• Assisting in monitoring of invoice returns and taking appropriate action on clinical queries as per the set deadline
• To assist in organizing and holding meetings with corporate clients to discuss status of their accounts regarding entitlements, exclusions and returned invoices and overall clinical reconciliation sign off
• Participate in Continuous Entitlements Education (CEE) for Clinical and non -clinical areas for excellent service delivery
• Assist in the coordination of renewal of corporate agreements and fulfillment of terms of the administration rules and guidelines from corporate clients
• Maintenance of timely and accurate departmental reports e.g., accounts opened/closed, rejection rate, individual corporate performance, copay schedules, CME meeting minutes
• Participate in preparation of all Institution and Financial audits to enable the Department to achieve its quality objectives
• Report any incidences regarding corporate credit management to the Supervisor
• Assist in the maintenance and monitoring of Master Register of Corporate accounts from inception to expiry timelines in order to hedge against provision of services to expired accounts.
• Continuous monitoring of hospital and outreach billing to ensure all claims comply with corporate requirement including but not limited to ensuring e-diagnosis is captured.

Qualifications and skills required

• Diploma in Nursing or equivalent
• Kenya Certificate of Secondary Education (KCSE) with mean grade C or its equivalent
• Proficient in MS Office Suite
• Formal training in customer care or equivalent demonstrated experience.
• A minimum of 1 (one) years’ experience in a busy claim vetting and assessment department
• A minimum of 1 (one) year’s exposure in clinical practice.
• A minimum of 3 (three) years’ experience in a busy accounting/credit management department
• Excellent communication skills both written and oral
• Excellent customer service skills
• Good interpersonal skills: Ability to build relationships among team members
• Ability to work under pressure and meet stringent deadlines.