Claims Assurance Officer - Embakasi

Person Specification

• Higher Diploma or Diploma in Health Records, Business Administration, or a related field.
  
• CPA, ACCA, Diploma in accounting or any other relevant training in accounting, relevant bachelor’s degree, or a related field.
  
• Minimum 3 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 & Assurance

• Verify completeness and accuracy of insurance documentation prior to service delivery.
  
• Ensure insurance and patient details are correctly entered in the system.
  
• Validate pre-authorizations, NHIF codes, QR codes, diagnosis, and required claim attachments.
  

Front Office Oversight

• Supervise client service teams to ensure compliance with billing and documentation SOPs.
  
• Conduct ongoing training on insurance procedures, documentation standards, and system updates.
  

Rejection Prevention

• Analyze claim rejection trends and address root causes.
  
• Identify high-risk claims and escalate incomplete or inconsistent documentation for immediate resolution.
  

Interdepartmental Coordination

• Act as liaison between clinical, reception, and finance departments to ensure seamless documentation flow.
  
• Coordinate with insurance providers for clarifications or additional documentation needs.
  

Reporting & Audit

• Prepare daily and weekly reports on documentation compliance, rejection metrics, and flagged claims.
  
• Support internal audits and help implement corrective action plans to improve claims quality.
  

Financial & Operational Oversight

• Monitor invoicing reports, banking transactions, and Oracle purchases.
  
• Assist in cost optimization initiatives and ensure inventory accuracy.
  

Customer Experience

• Resolve patient concerns regarding billing and documentation professionally.
  
• Support a patient-first approach by ensuring clarity and transparency in the billing process.
  
• Perform any additional duties as assigned by management to support the revenue assurance function.