Health Maintenance Organization (HMO) Officer at First Rivers Hospital Limited

First Rivers Hospital Limited is located at 7/9 Old Aba Road, Rumuomasi / 250 Aba Express way Port Harcourt, with modern equipment. Through over 150 staff, 78 of which are core healthcare professionals, we are committed to the provision of compelling quality timeless medical services to our patients. Our objective is to maximally exploit medical sciences in the art of health management and preservation of life with regards to The Ultimate Intelligence.

We are recruiting to fill the position below:

Job Title: Health Maintenance Organization (HMO) Officer

Location: Port Harcourt, Rivers
Employment Type: Full-time

Summary

• An HMO Officer manages Health Maintenance Organization (HMO) related activities for a healthcare provider, focusing on patient insurance verification, claims processing, billing, and liaising with HMO representatives to ensure accurate payments and compliance with regulations.
• Key responsibilities include verifying patient benefits, obtaining service authorizations, submitting and tracking claims, coordinating with billing departments, and resolving discrepancies to ensure timely processing of payments and services.
• The role requires strong administrative, communication, and problem-solving skills, along with accuracy and attention to detail.

Key Responsibilities
HMO Liaison:

• Act as the primary point of contact between the healthcare provider and HMOs, managing communications and building strong relationships.
• Patient Verification: Confirm patient eligibility and benefits with various HMOs to ensure they are covered for services.
• Authorization & Approvals: Obtain necessary approvals from HMOs for specific medical treatments or services.
• Claims Management: Prepare, submit, and track claims with HMOs, following up on rejected or pending claims to ensure prompt payment.
• Billing & Reconciliation: Work with the billing team to ensure accurate invoicing and reconcile HMO payments, outstanding balances, and discrepancies.
• Compliance: Ensure all HMO transactions and communications adhere to regulatory requirements and hospital policies.
• Problem Resolution: Address discrepancies and issues related to claims or coverage between patients and HMOs.
• Record Keeping: Maintain accurate and up-to-date patient records, HMO information, and relevant documentation.

Key Skills and Qualifications

• Administrative Skills: Proficiency in office software, such as MS Excel, is essential for managing data and generating reports.
• Communication Skills: Strong oral and written communication skills are necessary to interact effectively with HMO representatives and patients.
• Problem-Solving Skills: The ability to resolve issues with claims, billing, and patient coverage is crucial.
• Attention to Detail: High accuracy is required to ensure the correctness of patient information, billing, and claims.
• Organizational Skills: Multi-tasking abilities are important for managing various HMO-related tasks simultaneously.
• HMO Experience: Experience in hospital billing, HMO operations, or health insurance is highly valued.

Application Closing Date
Not Specified.

How to Apply
Interested and qualified candidates should submit their CV and a Cover Letter detailing their qualifications and experience to: vacancy2@firstrivers.com using the Job Title as the subject of the email.