Claims Assurance Assistant - Mombasa

Person Specification

• Diploma in Accounts, Business Administration, Health Records, , or a related field.
  
• CPA training is desirable
  
• Minimum 1-2 years of experience in a medical billing/revenue cycle role, preferably in a hospital or insurance setting.
  
• Knowledge of medical insurance procedures in Kenya (including SHA/SHIF, private insurance payers, etc.).
  

Claims Documentation & Support

• Obtain and verify pre-authorizations for insured patients before billing.
  
• Ensure claim forms are complete — including diagnosis, doctor’s notes/signatures, QR codes, and patient details.
  
• Check for consistency across patient charts, invoices, and claim attachments.
  

Invoice Preparation & Submission

• Generate, verify, and close accurate invoices in the billing system for cash, credit, and insurance patients.
  
• Match invoices to corresponding authorization codes and patient service records.
  
• Prepare claims for submission (physical and digital) and ensure daily dispatch logs are updated.
  

Reconciliation & Billing Follow-Up

• Track and follow up on claims pending due to exceeded limits, missing documentation, or rejections.
  
• Assist in reconciling billed amounts with insurer remittances or SHA statements.
  
• Log rejections and errors for trend analysis and continuous improvement reporting.
  

Patient & Interdepartmental Liaison

• Respond to patient billing queries with professionalism and accuracy.
  
• Liaise with clinical, front office, and finance teams to clarify service dates, diagnosis codes, or authorization needs.
  
• Alert relevant departments of billing or claim anomalies requiring correction.
  

Data Management & Compliance

• File and organize claim documents in line with internal filing protocols (digital and physical).
  
• Ensure compliance with patient data privacy laws (e.g., Data Protection Act, 2019).
  
• Update claim and invoice trackers to support real-time reporting.
  

Reporting & Administrative Support

• Generate basic reports on daily claims submitted, claims pending, and invoice status.
  
• Assist in updating SOP manuals or process checklists as needed.
  
• Support preparation for internal audits or insurer reviews by locating and compiling required documentation.
  

Continuous Learning & Systems Use

• Stay updated on SHA and private insurer billing requirements.
  
• Participate in internal training on claims, invoicing, and accounting systems.
  
• Contribute ideas for improving claims turnaround and documentation accuracy.