Avenue Healthcare Care Manager Job

Job Objective/Purpose

Ensure efficient and cost effective patient services as the case manager in liaison with third party payers, and ensure accurate and complete billing of patient services in accordance with the Hospital’s policies and procedures.

Key Responsibilities

• Conducts daily inpatient rounds of the specific scheme beneficiaries admitted in the hospital while ensuring timely and appropriate admission, diagnosis, and care of patients and advise the hospital and the corporate accordingly. 
• Ensure only authentic pre-authorizations are issued for clients seeking medical services in collaboration with the clinical team. 
• Draw monthly reports for specific corporate clients inclusive of trends, analysis, market intelligence for improved business development. 
• Liaise daily with other concerned units especially credit control and clinical department to seek amicable solutions to problems related to our billing and invoicing system. 
• Respond to inquiries concerning billing activities from patients, insurance companies, consultants or colleagues in a professional and efficient manner. 
• Conduct a regular review of the case process to identify gaps to enhance profitability as well as efficiency and effectiveness in the case management process. 
• Enhance customer experience – establish and maintain good relationships with external and internal stakeholders such as underwriter’s, brokers, agents, and policy holders. 
• Conduct review of patients’ billing statements and all discharged patients’ bills for accuracy and completeness prior to finalization of the invoices. 
• Provide billing information by collecting, analyzing, and summarizing third-party billings, accounts pending, and late charges data and trends. 
• Prepare billing statements for insurance companies, patients and other third parties. 
• Participate in audits, service evaluations and process reviews to enhance the delivery of billing service to customers/stakeholders. 
• Ensure that Avenue Healthcare corporate governance policies are adhered to, including preventing, detecting, and reporting any fraud or criminal activities, and Implementing audit recommendations. 
• Ensure adequate knowledge of, and compliance to all Avenue Healthcare policies, procedures, and systems, especially policies pertaining to the provision of medical services and finance.

Personal Specifications

• Diploma in Nursing (KRCHN) and a valid Nursing License from NCK
• Finance, Accounting or Insurance Professional qualification
• Minimum of 3 – 4 years’ experience in a similar role
• Customer focus and results oriented
• Strong interpersonal skills, team playing abilities, and communication skills.
• Highly responsive, ethical and responsible

How To Apply

Application documents (CV and Certificates) must be emailed to vacancies@avenuehealthcare.com with the job position you are applying for as the subject of the email by 15th February 2024