Medical Vetting Officer job at NFT Consult

Client Summary:

Our Client is part of the healthcare cluster of CIEL Group, and is a leading healthcare provider in Uganda and the region, delivering the most caring medical expertise, always putting our patients first.

Position Summary:

This job is critical to accurate and complete billing of services in the organization; and the collection of payments for services rendered.

Duties and Responsibilities:

• Review all medical and non-medical errors on each claim.
• Ensure that all sections of all insurance claim forms are completed with no omissions.
• Ensuring the doctor’s prescription matches the diagnosis and completeness of their signatures.
• Ensure that all IPD and theatre claims/invoices are submitted with guarantees of payment attached.
• Ensure that all Un-smarted claims are submitted with an off-smart authorization attached.
• Ensure that all monthly claims of all insurance companies and corporates are fully submitted by the 2nd of every month.
• Ensure that the invoiced/submitted amount per insurer matches the final reported system amount per month
• Obtain remittance advice per insurer every month specifying paid amounts and rejected amounts per bill.
• Make a summary of rejections per insurance company, invoice number, amounts, and patient names.
• Classify all rejections into major reasons for rejection.
• Identify justifications for medical rejections and correct errors on non-medical claims.
• Identify reclaimable bills per insurer, re-submit, and attend reconciliation meetings with insurance companies.
• Communicate common reasons for rejections with the responsible officers to avoid a repeat of the same.
• Identify rejections due to negligence and attach to responsible officers for recovery
• Compile a daily report on work done (invoices received, vetted and rejected) per biller and per insurer
• Any other task that may be assigned to you from time to time

Qualifications and Experience:

• A good first degree/diploma in clinical medicine.
• Good and demonstrable understanding of IMG Philosophy, Vision and strategy (desirable)
• Good interpersonal skills.
• Good communication skills (Verbal & Written) to communicate effectively with clients, the team and other staff.
• Good and demonstrable leadership skills (desirable)
• Computer Literacy especially MS Office
• Knowledge and ability to use Navision. (critical)
• A good first degree or diploma with an accounting emphasis
• Experience in a similar field is desired.

• Review all medical and non-medical errors on each claim.
• Ensure that all sections of all insurance claim forms are completed with no omissions.
• Ensuring the doctor’s prescription matches the diagnosis and completeness of their signatures.
• Ensure that all IPD and theatre claims/invoices are submitted with guarantees of payment attached.
• Ensure that all Un-smarted claims are submitted with an off-smart authorization attached.
• Ensure that all monthly claims of all insurance companies and corporates are fully submitted by the 2nd of every month.
• Ensure that the invoiced/submitted amount per insurer matches the final reported system amount per month
• Obtain remittance advice per insurer every month specifying paid amounts and rejected amounts per bill.
• Make a summary of rejections per insurance company, invoice number, amounts, and patient names.
• Classify all rejections into major reasons for rejection.
• Identify justifications for medical rejections and correct errors on non-medical claims.
• Identify reclaimable bills per insurer, re-submit, and attend reconciliation meetings with insurance companies.
• Communicate common reasons for rejections with the responsible officers to avoid a repeat of the same.
• Identify rejections due to negligence and attach to responsible officers for recovery
• Compile a daily report on work done (invoices received, vetted and rejected) per biller and per insurer
• Any other task that may be assigned to you from time to time

• Good interpersonal skills.
• Good communication skills (Verbal & Written)
• Good leadership skills (desirable)
• Computer Literacy especially MS Office
• Knowledge and ability to use Navision. (critical)

• A good first degree/diploma in clinical medicine.
• A good first degree or diploma with an accounting emphasis