Hospital HMO Manager Job at Syx-Brij Nigeria Limited

Syx-Brij Nigeria Limited - Our client, Vima Hospital, is recruiting to fill the position below:

Job Position: Hospital HMO Manager
Job Location: Ikorodu, Lagos
Employment Type: Full-time

Responsibilities
HMO Liaison:

  • Serve as the primary point of contact between Vima Hospital and Health Maintenance Organizations.
  • Manage communication, negotiations, and relationship-building with HMO representatives.

Verification and Authorization:


  • Verify patient eligibility and coverage with HMOs.
  • Obtain necessary authorizations for medical procedures, tests, and treatments covered by HMO plans.

Billing and Claims:

  • Ensure accurate and timely submission of patient claims to HMOs.
  • Coordinate with the billing department to resolve any discrepancies or issues related to HMO billing.

Documentation and Record-Keeping:

  • Maintain comprehensive and up-to-date records of HMO-related transactions, authorizations, and communications.
  • Prepare reports on HMO utilization, claims, and reimbursement.

Educational Outreach:

  • Educate patients on their HMO coverage, benefits, and responsibilities.
  • Provide guidance on navigating HMO processes and requirements.

Conflict Resolution:

  • Address and resolve any issues or disputes between Lifeshade Hospital and HMOs.
  • Collaborate with internal departments to ensure compliance with HMO agreements.

Compliance:

  • Stay abreast of changes in HMO policies, regulations, and industry trends.
  • Ensure hospital practices align with HMO contractual agreements and regulatory requirements.

Qualifications

  • Bachelor's degree in Healthcare Administration, Business Administration, or a related field can be a bonus.
  • Proven experience working in a similar role within the healthcare industry.
  • Detail-oriented with excellent organizational and problem-solving abilities.
  • In-depth knowledge of HMO processes, policies, and regulations.
  • Strong communication and negotiation skills.
  • Ability to work collaboratively in a fast-paced healthcare environment.


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