We are seeking a detail-oriented and experienced Billing & Claims Officer to manage patient invoicing, insurance claims processing, and financial reconciliation within a healthcare facility. The successful candidate will be responsible for generating accurate patient bills, submitting claims to NHIF, SHA, and private insurers, and ensuring timely follow-up and resolution of outstanding or rejected claims. This role also involves regular communication with patients and insurance providers, maintaining organized billing records, and ensuring compliance with hospital and regulatory policies. The ideal candidate will have a strong background in hospital billing, a solid understanding of Kenya’s health insurance systems, and proficiency in hospital management systems.

Duties and Responsibilities

Patient Billing & Invoicing

• Generate accurate invoices for all patient services including consultation, lab tests, imaging, surgery, medication, and ward charges.
• Confirm patient insurance status and coverage before billing.
• Work closely with reception, nursing, pharmacy, and clinical departments to ensure all billable services are captured correctly in the hospital management system.

Claims Management (NHIF/SHA/Private Insurers)

• Prepare and submit claims to NHIF, SHA, and insurance companies in the prescribed formats and timelines.
• Verify patient eligibility and benefits before submission of claims.
• Attach all necessary documentation, including patient records, prescription notes, treatment summaries, and consent forms, to claims.

Reconciliation and Follow-up

• Track submitted claims and ensure timely payment.
• Investigate and resolve unpaid, denied, or rejected claims by liaising with insurers, NHIF/SHA, and internal departments.
• Reconcile remittances received from NHIF/SHA/insurance against submitted claims to identify variances.

Patient and Insurer Liaison

• Respond to patient inquiries regarding billing, insurance coverage, and outstanding balances.
• Communicate with insurance providers and NHIF/SHA offices to resolve claim discrepancies.
• Provide preauthorization support where required for procedures or admissions.

Reporting and Documentation

• Prepare daily, weekly, and monthly billing and collection reports for hospital management.
• Maintain comprehensive and organized billing records in accordance with hospital and regulatory requirements.
• Assist in audits by providing billing records and explanations as needed.

Compliance and Quality Assurance

• Ensure billing practices comply with hospital policies, NHIF/SHA regulations, and insurance agreements.
• Regularly update knowledge on NHIF/SHA changes and ensure hospital billing aligns with the latest policies.
• Identify and report any fraudulent or irregular billing activity.

Key Requirement Skills And Qualification

• Diploma or Bachelor’s Degree in Accounting, Finance, Business Administration, Health Records and Information, or a related field
• Minimum 2–3 years of working experience in hospital billing or in a health insurance company, specifically handling NHIF and insurance claims
• Proficient in using hospital management systems (e.g. Smart HIMS, AfyaPro, Med360, etc.)
• Deep understanding of Kenya’s health insurance landscape, including NHIF, SHA, and private insurers
• Knowledge of medical terminology, procedures, and diagnosis codes (ICD-10) is a strong advantage

HOW TO APPLY

If you meet the above qualifications, skills and experience share CV on email.

Interviews will be carried out on a rolling basis until the position is filled.

Only the shortlisted candidates will be contacted.

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