Insurance Supervisor

• Review all medical and non-medical errors on each claim.
• Ensure that all sections of all insurance claim forms are completed with no omissions.
• Ensure that the doctor’s prescription matches the diagnosis and that their signatures are complete.
• 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 5th 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, resubmit, 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 them to responsible officers for recovery
• Compile a daily report on work done (invoices received, vetted, and rejected) per biller and per insurer.
  
•  Claims vetting – Conduct daily claims and system audits to ensure that all clients who come to the hospital are billed correctly.
•      Ensure that the right entries are entered into Eafya and the 3rd party billing systems.

        Ensure that the Day and Night invoices are vetted on a daily basis.

  Review claims for completeness, accuracy, and compliance with insurance and regulatory requirements.

  Invoice handling:  Review interim bills and discharges daily and ensure the creation of bills that meet the standards of insurance and cash patients.

o Oversee billing, pricing, and insurance claims management for all insurance companies
• Invoice submission and reconciliation. o Supervise and coordinate daily operations of the claims department, including claim preparation, submission, follow-up, and reconciliation.
o Ensure all claims are submitted accurately and within payer timelines to avoid
rejections or delays.
o Investigate and resolve denied, underpaid, or delayed claims, coordinate appeals and
resubmissions as necessary.
o Liaise with insurance companies, patients, and internal hospital departments to
resolve claim issues.

·     Liaison with Insurance Companies /stakeholder management– o Review preauthorization forms for completeness/ justification and follow up on insurance response

To make sure that all communication from invoicing companies is disseminated to all users and all required parties promptly, e.g., new updated lists, off list and contract updates.
o Follow up on any queries as regards guarantees of payment, authorization requests
and provide any other clarity required from insurance companies as required.

Job requirements and qualifications
Qualifications:
• Bachelor of Medicine and Surgery
• Strong background and prior experience/ exposure to medical claims
• Strong knowledge of healthcare insurance processes, billing systems, and medical terminology.
• Excellent leadership, analytical, and problem-solving skills.
• Strong interpersonal and communication abilities for interacting with insurers, patients, and hospital staff.

How to Apply:

All applications will be received and reviewed through the BrighterMonday Portal by clicking on the 'Apply Here' section