Claims Assurance Assistant - Kikuyu

Key Responsibilities:

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.

Industries:Health, Wellness & Fitness

Function: Others