3 weeks ago
Job Summary
The HMO Officer manages the administration and operation of health maintenance services, ensuring high-quality member care and regulatory compliance. This role involves overseeing member services, processing claims, managing provider networks, and implementing health promotion programs.
- Minimum Qualification : HND
- Experience Level : Entry level
- Experience Length : 1 year
Job Description/Requirements
Requirements:
Member Services Management:
- Ensuring high-quality service for HMO members.
- Handling member inquiries, complaints, and grievances.
- Coordinating with healthcare providers to address members' needs.
Compliance and Regulation:
- Ensuring that the HMO complies with federal, state, and local regulations.
- Keeping up-to-date with healthcare laws and industry standards.
- Overseeing audits and implementing necessary changes based on findings.
Claims Processing:
- Reviewing and processing insurance claims submitted by healthcare providers.
- Ensuring accuracy and compliance with HMO policies.
- Resolving disputes and discrepancies related to claims.
Provider Network Management:
- Recruiting and credentialing healthcare providers.
- Maintaining and updating the list of in-network providers.
- Ensuring providers adhere to HMO policies and quality standards.
Health Promotion and Disease Prevention:
- Implementing and promoting wellness programs.
- Coordinating preventive care initiatives and health education activities.
- Monitoring health outcomes and improving care quality.
Data Management and Reporting:
- Analyzing and reporting on healthcare utilization and outcomes.
- Maintaining accurate records of members and claims.
- Using data to identify trends and improve services.
Operational Efficiency
- Streamlining processes to enhance operational efficiency
- Managing budgets and financial resources related to member services and claims.
- Overseeing staff training and development.
Collaboration and Communication:
- Working closely with healthcare providers, insurance companies, and other stakeholders.
- Facilitating communication between members, providers, and the HMO.
- Coordinating internal teams to address issues and implement improvements.
- Overall, the HMO Officer's role involves a mix of administrative, compliance, and strategic responsibilities aimed at ensuring the effective delivery of healthcare services while meeting regulatory requirements and member needs.
Requirements:
- 1 year experience
- Minimum of HND
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