Senior Claims Officer
Africa Healthcare Network (AHN) is looking for a Senior Claims Officer to manage the overall activities of the centralized billing office in each country AHN operates. AHN is building the first dialysis chain across East Africa, providing high-quality, life-saving dialysis at an affordable cost to both the local patient population and patients from neighbouring countries, which do not have centres of their own. AHN brings world-class technical expertise combined with developing world practical operating experience to a region in dire need of quality dialysis treatment. In North America, over 97% of patients requiring treatment for kidney disease receive care; in East Africa, less than 5% receive care. AHN's goal is to increase access to high quality care at a lower cost to patients, delivered through a sustainable business model. AHN is currently operating in Rwanda, Kenya and Tanzania.
Need: Next 6 months
AHN is seeking a highly-motivated individual with outstanding leadership and management qualities to fill the position of Senior Claims Officer (SCO), region based in Dar es Salaam. The SCO will be responsible for providing oversight and direction for the company’s Tanzania authorization, billing, and accounts receivable activities. They will oversee billing and collections processes associated with center operations and all payer sources (government & non-government) to ensure an accurate billing and timely receivables management. This includes ensuring compliance with billing and authorization requirements. This position will work closely with the CFO, CEO, and Tanzania Country Head, on short term and long-term strategic goals associated with receivables management while also ensuring ongoing process improvement initiatives. The SCO is further responsible for managing and training junior claims officers and ensuring a cohesive team environment that fosters growth and development. We are looking for a goal-oriented, personable and collaborative team member who understands and respects cultural subtleties and can help maintaining a shared vision with positive outcomes both from personnel and productivity perspective.
Roles & Responsibilities
Responsible for company’s authorization, billing, and accounts receivable activities
Designs and implements strategies to optimize AHN’s billing, claims, and collections processes ensuring AHN is positioned for success as the organization grows
Oversees authorization, billings, claims, and collections processes, ensuring each center has clearly defined roles, responsibilities and processes for ensuring accurate authorizations and billing for all patients
Ensures ongoing quality assurance audits and reviews of billing and collection processes are happening in a timely manner
Support New Center Operations team to align patient registration process, documentation, and information flows upon each new center launch to optimize billings and claims process
Monitors timeliness and effectiveness of billing and collection, ensuring that outstanding patient accounts and accounts receivable is no more than the agreed upon limit and that bad debt is minimized.
Ensure all billing and collection practices are compliant with all local and national requirements; Stay informed and disseminate pertinent regulatory and insurance related information
Ensures that claims and billings officers receive ongoing training/cross-training and are knowledgeable regarding all claims, billings, and collections functions
Works across with internal and external stakeholders to quickly and effectively resolve any billings or collections problems
Maintains all ageing reports and tracks trends, consistently keeping Finance team informed of trends in AR days and receivables outstanding, and escalating concerns as they arise
Assists center managers and hospital partners in resolving billing problems
Conducts follow-up collection efforts with hospital and/or insurance payer leadership as required.
Monitors any denials and appeals with hospital and insurance payers to resolve in a timely manner
Work closely with the CFO, COO, Country Head, on short term and long-term strategic goals associated with receivables management while ensuring ongoing process improvement mechanisms.
Nurture relationships and liaise professionally with government partners, corporate, multi-lateral, public institutions, and maintain a thorough understanding of the health landscape in Tanzania
Support with other senior level strategic initiatives as directed by CFO, CEO and Country Heads
Bachelor’s degree required; Master’s degree preferred in Accounting or Business Administration, or equivalent business experience;
At least 5 years of work experience in the private or public sector, with increasing levels of responsibility and leadership, and at least 3 years working in a healthcare claims and billing setting in East Africa
Well versed in billing guidelines for both government and non-government payer sources.
Experience conceiving, planning and executing complex programs or projects with verifiable results;
Exceptional written and oral communications skills;
Demonstrated strong analytical and problem solving skills;
Ability to work through sensitive political contexts and develop strong relationships with government officials and multilateral organizations;
Ability to work with limited budgets without extensive structural or operational support;
Strong work ethic and flexibility, respectful of local norms and culture, ability to work with humility and urgency;
High levels of proficiency in Microsoft Word, Excel, PowerPoint
Competitive salary (w/ performance bonuses), comprehensive health insurance, and travel allowance
Working with the best people in the sector and making an impact to the millions of people living in the region without high quality care
Our relentless commitment to personal development and career growth
Interested applicants should please submit their CV to Katharine Bodnar (firstname.lastname@example.org) and Judith Mziray (email@example.com)