Job Purpose:The role holder will be responsible for Medical Accounting including; Fund management, premium collections, provider reconciliations and ensuring that provider payment are made on time
Payments and Reconciliation
- Prepare monthly hospital payout targets for major providers and send the list to the Medical Claims Team
- Generate and send remittance advice for payments made to the respective medical providers including the invoice details.
- Review payouts on a regular basis with an aim of ensuring that monthly payout targets for major providers are met.
- Perform reconciliations with provider statements and ensure resolution of outstanding balances on a timely basis.
- Reconcile Britam Credit account facilities with the various providers and ensure the same is maintained within the agreed SLAs.
- Monitor medical provider guarantees to ensure timely renewal of expired guarantees and cancellations for discontinued providers.
Fund & Insured Schemes Management
- Monitor utilization of funded schemes and follow up on replenishment at 75% utilization
- Generate and issue monthly fund utilization statements and Insured schemes on request
- Advise cashier on the receipting and allocation for all medical collections including; Insured premiums, Funded schemes, and card costs
- Perform monthly reconciliation of funded schemes and agree to balances to ERP General Ledger Out Patient fund account.
- Generate Insured premium statement and facilitate collection of the same with the Sales team and intermediaries
- Reconciliation and collection/recovery of medical claims paid outside the policy.
- Process medical premium refunds to client