Job Description
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Aga Khan University Hospitals in Karachi, Pakistan and Nairobi, Kenya are private, not-for-profit institutions providing high quality health care. The Main Hospitals serve as the principal sites for clinical training for the University’s Medical Colleges and Schools of Nursing and Midwifery in Pakistan and East Africa. Our Vision of Aga Khan University Hospital, Nairobi is to be the premier, tertiary, teaching and referral health care facility in sub-Saharan Africa. ​For over fifty years, Aga Khan University Hospital, Nairobi (AKUH) has been taking care of families in East Africa. As a private, not-for-profit hospital, we strive to provide access to quality healthcare to all who need it. At AKUH, patients are our first priority. Our team of medical professionals, faculty and staff are here to provide you and your loved ones with the highest standards of healthcare. We are committed to working together to ensure that you and your family receive outstanding medical services, first-rate facilities and compassionate care. The Aga Khan University Hospital, Nairobi has set the standard for comprehensive healthcare and modern medical education in East Africa. Our dedicated staff, advanced facilities and state-of-the-art technologies have earned the hospital great reputation as a leading medical institution and teaching hospital in the region, and beyond. Patients benefit from our unique team-based approach to car​e, which enables you to benefit from the diverse expertise of our entire team of medical professionals. As the teaching hospital for Aga Khan University’s Medical College and School of Nursing and Midwifery, we practice an evidence-based approach to medicine, driven by the cutting-edge research conducted by our experienced faculty members. Our approach to care is guided by our core principles of Quality, Access, Impact and Relevance.​
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.