HMO Officer
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Job summary
An HMO Officer manages the relationship between patients, healthcare providers, and Health Maintenance Organizations (HMOs). They facilitate seamless access to care by verifying insurance eligibility, obtaining treatment approvals (pre-authorizations), managing medical claims, and resolving billing disputes.
Min Qualification:
HND
Experience Level:
Entry level
Experience Length:
1 year
Language Requirement:
English
Working Hours:
Full Time - 8 to 5
Applicant Location:
Lagos, Nigeria
Job descriptions & requirements
Responsibilities:
- Verification & Pre-authorization: Confirm patient coverage and obtain necessary approval codes from HMOs for consultations, medications, and medical procedures.
- Claims Management: Prepare, submit, and track accurate medical bills and claims to insurance providers.
- Liaison: Serve as the primary point of contact between the hospital/clinic and various HMOs.
- Dispute Resolution: Follow up on unpaid invoices and resolve rejected or delayed claims to minimize financial loss.
- Customer Service: Address patient and HMO inquiries regarding coverage status, billing discrepancies, and medical expressions.
Requirements:
- Minimum of an HND in Healthcare Administration, Public Health, Nursing, Accounting, Finance, or Business Administration.
- Typically 1-2 years of hands-on experience in medical billing, claims processing, or HMO management within a hospital or insurance setting.
- Strong understanding of medical coding, proficiency in Microsoft Office (specifically Excel), excellent negotiation skills, and close attention to detail.
- Outstanding verbal and written communication, strong problem-solving skills, and the ability to multitask in a fast-paced healthcare environment.
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