Medical Administrator – Billing & Clinical Administration

Qualifications & Experience

• Diploma or Bachelor’s Degree in Health Records, Business Administration, Finance, or a related field from a recognized institution.
  
• Minimum 2–3 years’ progressive hands-on experience in hospital billing, health records tracking, or medical insurance administration.
  
• Strong working knowledge of SHA/NHIF processes, medical coding frameworks, and private medical insurance systems within Kenya.
  
• Demonstrated experience working with Electronic Health Records and hospital billing or inventory modules.
  

Key Skills & Competencies

• Strong understanding of healthcare billing, insurance verification, and hospital revenue cycles.
  
• Up-to-date knowledge of SHA/NHIF rules, claims validation processes, and private insurer reimbursement structures.
  
• High attention to detail, numerical accuracy, and reconciliation skills.
  
• Strong interpersonal communication and coordination skills across clinical, pharmacy, laboratory, and finance teams.
  
• Ability to multitask and work under pressure in a fast-paced, high-volume outpatient clinic environment.
  
• High professional ethics, financial accountability, confidentiality, and commitment to data protection.
  

Billing & Revenue Cycle Management

• Capture patient charges accurately across consultations, procedures, pharmacy, laboratory, and consumables.
  
• Prepare and issue invoices, receipts, and statements through computerized healthcare systems.
  
• Ensure complete charge capture to minimize revenue leakage across all service lines.
  
• Reconcile daily billing transactions against clinical services delivered and maintain accurate electronic billing records within the EHR system.
  

Insurance Claims Management

• Process insurance claims for the Social Health Authority, formerly NHIF, and private medical insurers.
  
• Verify patient eligibility, benefit coverage, and pre-authorization requirements before service delivery.
  
• Ensure correct coding of diagnoses, procedures, and medical services for compliant claims submission.
  
• Submit claims within required timelines and follow up on approvals, rejections, pending codes, and documentation gaps.
  

Clinical Administration & Controls

• Ensure accurate entry and complete closure of patient records within the EMR system.
  
• Support clinicians in maintaining complete documentation required for billing and insurance approval.
  
• Verify alignment between clinical notes, prescriptions, diagnostic investigations, and final billed services.
  

Cashiering & Financial Reconciliation

• Process patient payments securely across cash, card, and mobile money channels.
  
• Maintain daily cash reconciliation, banking records, and support internal financial audit readiness.
  

Departmental Coordination

• Coordinate with pharmacy and laboratory teams to ensure all diagnostics, dispensed items, and consumables are captured and billed correctly.
  
• Work with clinicians to resolve missing, unclear, or incomplete documentation affecting billing or claims processing.
  
• Support efficient patient flow and reduced waiting time through active administrative and queue coordination.
  

Compliance & Audit Support

• Ensure compliance with SHA/NHIF regulations, private insurer requirements, institutional billing policies, patient confidentiality standards, and data protection regulations.
  
• Participate in internal and external financial, insurance, and clinical documentation audits.