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Nursing Officer Job in Kenya

Title: Nursing Officer (Health Division)
Reports to: Head of Health Division
Job Summary: The jobholder will be responsible for Claims Processing, Hospitals undertakings and Visits, Customer Care, credit vetting and control and bills reconciliation and approval as per the company policy guidelines.

  • Keying of claims – both reimbursement and credit.
  • Vetting of claims, checking on what is payable and not payable, either due to the nature of illness or mode of treatment or payment within the Kenya Medical Practitioners & Dentist Board guidelines.
  • Assisting colleagues on interpreting and processing of claims i.e. ensuring diagnosis is within medical insurance cover and diagnosis matches treatment offered.
  • Liaise with doctors, brokers and clients at large for patient admissions.
  • Advise members on how best to utilize their benefits by recommending cheaper facilities and cheaper options e.g. maternity packages, chronic management facilities.
  • Advising doctors on referral of patients with chronic illness to cheaper facilities.
  • Capping/reviewing of undertaking through advise through letters to providers where and when necessary to avoid exceeded limits and hospitals/doctors taking advantages.
  • Sending undertakings to providers within the timelines.
  • Go through pre-authorization forms and scrutinize forms especially for clear diagnosis management and nature of treatment.  Requesting for further information/medical reports where treatment needs.
  • Nurturing a good relationship with doctors, hospitals, brokers and other service providers.
  • Patient visits for psychological support and ensuring they are receiving proper medical treatment.
  • Updating providers with current list of members covered, those who have exceeded limits and not to access services.
  • Arrange for health talks / cover review and ways of reducing over usage for clients.
  • Come up with a sufficient and efficient credit panel for our entire clientele.
  • Ensure all credit providers are kept in check and ensuring smooth relationship between our credit panel and ourselves.
  • Provider reconciliation and liaise with brokers on where member accessed service not authorized which needs to be paid to providers.
  • Sending invoices of exceeded limits to Brokers / Companies for payment.
If you meet the above minimum requirements, send your c.v to indicate the position applied for on the email subject line so as to be received not later than 13th March, 2013.

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