HMO Officer

Responsibilities: 

Verification & Pre-authorization: Confirm patient coverage and obtain necessary approval codes from HMOs for consultations, medications, and medical procedures. Claims Management: Prepare, submit, and track accurate medical bills and claims to insurance providers. Liaison: Serve as the primary point of contact between the hospital/clinic and various HMOs. Dispute Resolution: Follow up on unpaid invoices and resolve rejected or delayed claims to minimize financial loss. Customer Service: Address patient and HMO inquiries regarding coverage status, billing discrepancies, and medical expressions.

Requirements:

Minimum of an HND in Healthcare Administration, Public Health, Nursing, Accounting, Finance, or Business Administration. Typically 1-2  years of hands-on experience in medical billing, claims processing, or HMO management within a hospital or insurance setting. Strong understanding of medical coding, proficiency in Microsoft Office (specifically Excel), excellent negotiation skills, and close attention to detail. Outstanding verbal and written communication, strong problem-solving skills, and the ability to multitask in a fast-paced healthcare environment.