HMO / Billing Officer

Position Overview

The HMO/Billing Officer manages all aspects of billing operations, including processing HMO claims and general patient billing. The role ensures accurate and timely submission of claims, reconciliation of payments, compliance with policies and contracts, and excellent service delivery to patients and HMO partners.

Key Responsibilities

HMO Claims Management

• Prepare, verify, and submit HMO claims in accordance with contractual agreements
• Ensure completeness of patient records, authorization forms, treatment plans, and invoices
• Follow up with HMOs on outstanding claims, rejections, or denials
• Reconcile HMO payments against billed amounts and resolve discrepancies

Patient Billing

• Generate accurate invoices for patients for all services rendered
• Ensure proper posting of transactions to patient accounts
• Collaborate with patient services and finance teams to resolve billing queries

Documentation & Compliance

• Maintain detailed records of all billing and HMO claim activities
• Ensure compliance with HMO contractual terms, hospital billing policies, and regulatory requirements
• Prepare documents for internal and external audits

Required Qualifications

• Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Management, or related field
• Prior experience in HMO claims, healthcare billing, or medical claims processing is an advantage

Skills & Competencies

• Knowledge of HMO claim processes and billing software
• Strong numerical, analytical, and reconciliation skills
• Attention to detail and accuracy
• Excellent communication and interpersonal skills
• Ability to multitask, prioritize, and work under deadlines
• Proficiency in Microsoft Excel and hospital billing systems

Working Conditions

Office-based within a hospital setting with frequent interaction with clinical, administrative, and finance teams.