Hmo Officer At Westcare Specialist Hospital

Westcare Specialist Hospital is seeking a competent, detail-oriented, and experienced HMO Officer to join our team. The ideal candidate will be responsible for managing HMO-related processes, coordinating with HMO partners, and ensuring seamless healthcare services for eligible patients.

Key Responsibilities

• Liaise with HMOs, retainerships, and corporate organizations to confirm patient eligibility and obtain pre-authorizations.
• Ensure proper documentation and processing of bills for HMO and insurance patients.
• Monitor and follow up on outstanding claims to ensure timely reimbursement.
• Educate patients on HMO coverage, exclusions, procedures, and other relevant information where necessary.
• Act as an intermediary between the hospital, clients, and HMO partners.
• Obtain approval codes for eligible patients by accurately entering requested services on HMO portals.
• Communicate with HMOs via email and other approved channels regarding approvals, patient care, required information, and other necessary matters.
• Maintain accurate records of HMO transactions, approvals, claims, and correspondence.
• Ensure compliance with HMO policies and the hospital's internal procedures.