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Job Description/Requirements ABOUT THE COMPANY Avenue Hospital was founded in 1995 for the purpose of managing the outpatient department at the Hospital, and to extend medical services to corporate clientele through an innovative concept of Managed Healthcare. Our Purpose Our purpose is to maintain and enable health Our Mission To provide high quality medical care that exceeds the needs of our clients Our Culture and Core Values Respect - For all human beings regardless of financial status, race, tribe, national origin, religious or political beliefs Service - Providing the best service to our patients, their families, doctors, clients, business partners and staff Excellence - Continually striving to improve and achieve excellence in the provision of our services Job Summary Person SpecificationDiploma in Accounts, Business Administration, Health Records, , or a related field.CPA training is desirableMinimum 1-2 years of experience in a medical billing/revenue cycle role, preferably in a hospital or insurance setting.Knowledge of medical insurance procedures in Kenya (including SHA/SHIF, private insurance payers, etc.). Responsibilities Claims Documentation & SupportObtain and verify pre-authorizations for insured patients before billing.Ensure claim forms are complete — including diagnosis, doctor’s notes/signatures, QR codes, and patient details.Check for consistency across patient charts, invoices, and claim attachments.Invoice Preparation & SubmissionGenerate, verify, and close accurate invoices in the billing system for cash, credit, and insurance patients.Match invoices to corresponding authorization codes and patient service records.Prepare claims for submission (physical and digital) and ensure daily dispatch logs are updated.Reconciliation & Billing Follow-UpTrack and follow up on claims pending due to exceeded limits, missing documentation, or rejections.Assist in reconciling billed amounts with insurer remittances or SHA statements.Log rejections and errors for trend analysis and continuous improvement reporting.Patient & Interdepartmental LiaisonRespond to patient billing queries with professionalism and accuracy.Liaise with clinical, front office, and finance teams to clarify service dates, diagnosis codes, or authorization needs.Alert relevant departments of billing or claim anomalies requiring correction.Data Management & ComplianceFile and organize claim documents in line with internal filing protocols (digital and physical).Ensure compliance with patient data privacy laws (e.g., Data Protection Act, 2019).Update claim and invoice trackers to support real-time reporting.Reporting & Administrative SupportGenerate basic reports on daily claims submitted, claims pending, and invoice status.Assist in updating SOP manuals or process checklists as needed.Support preparation for internal audits or insurer reviews by locating and compiling required documentation.Continuous Learning & Systems UseStay updated on SHA and private insurer billing requirements.Participate in internal training on claims, invoicing, and accounting systems.Contribute ideas for improving claims turnaround and documentation accuracy. Required Skills Reporting, Handling claims, General insurance, Communication Required Education Diploma, Associate's degree Show more Show less
