BENEDICT RENATUS MLALI

• . Claims Verification & Submission
  Review inpatient and outpatient claims to ensure accuracy, completeness, and compliance with NHIF (National Health Insurance Fund) and private insurer guidelines.
• Submit claims electronically through online platforms (NHIF portal) or manually, as required.
• Handling Rejections & Follow‑Ups
  Monitor claim rejections, delays, or underpayments, and take corrective measures in coordination with insurers.
• Liaise with internal billing, clinical, and admissions teams to resolve discrepancies.
• Reconciliation & Reporting
  Maintain detailed records of claim statuses, communication with insurers, and payments.
  
  Produce regular reports
• Compliance & Regulatory Updates
  Stay updated on Ministry of Health, NHIF rules, and private insurer policy changes.
  
  Ensure all claims and processes follow applicable national healthcare and insurance compliance standards.
• Training .
  Provide guidance and training to staff on correct documentation, insurer policy compliance, and claim submission best practices.

1. Patient Billing & Invoicing
Generate bills for inpatient, outpatient, emergency, and diagnostic services.

Ensure billing is aligned with the patient's treatment, medications, procedures, and services received.

Apply insurance cover, discounts, and package rates as applicable.

2. Insurance Handling
Coordinate with the insurance desk to verify patient coverage.

Process insurance claims and follow up on approvals and reimbursements.

Maintain accurate insurance documentation.

3. Cash Handling & Payment Collection
Accept payments through cash, card, UPI, or online transfers.

Issue official receipts and maintain daily transaction logs.

Ensure reconciliation of collected amounts with system entries.

4. Record Keeping & Reporting
Maintain detailed billing records for audits and compliance.

Generate daily, weekly, and monthly billing reports.

Help identify and report discrepancies or financial anomalies.

5. Coordination with Medical & Admin Staff
Collaborate with doctors, nurses, and admin staff to confirm services rendered.

Ensure billing matches medical records and prescribed treatments.

6. Customer Service
Resolve patient queries related to billing, insurance, or payment.

Guide patients or their families through the discharge and billing process.

Maintain a courteous and professional demeanor.

• 1. Front Desk Operations
  Greet and welcome patients, visitors, and vendors in a courteous and professional manner.
  
  Ensure a clean and organized reception area at all times.
  
  Respond promptly to inquiries in person, over the phone, or via email.
  2. Patient Registration & Appointments
  Register new patients by collecting and verifying personal and medical information.
  
  Schedule, reschedule, and cancel appointments using hospital management software.
  
  Confirm upcoming appointments and follow up on missed ones.
  3. Documentation & Records Management
  Maintain accurate patient records and update them regularly.
  
  Handle incoming and outgoing correspondence including medical reports, referrals, and bills.
  
  Ensure confidentiality and proper handling of sensitive information in compliance with healthcare regulations
  4. Communication & Coordination
  Coordinate with doctors, nurses, lab staff, and departments to ensure smooth patient flow.
  
  Notify medical staff of patient arrivals or delays.
  
  Relay messages and direct calls to the appropriate staff or department.
  5. Billing & Payments
  Provide information regarding consultation fees, insurance coverage, and payment procedures.
  
  Collect payments and issue receipts; maintain petty cash records if applicable.
  
  Assist with insurance form completion and claims processing.
  6. Emergency & Special Situations Handling
  Stay calm and assist during medical emergencies—call emergency codes or help direct patients to urgent care as needed.
  
  Follow hospital protocols for infectious disease prevention and emergency evacuations.
  8. Customer Service & Patient Care
  Provide accurate information about hospital services, visiting hours, and directions.
  
  Handle complaints or concerns politely and escalate to supervisors when needed.
  
  Ensure a patient-friendly experience from entry to exit.