Job Summary
The HMO Officer is responsible for managing the hospital’s HMO activities and ensuring smooth coordination between the hospital, Health Maintenance Organizations (HMOs), corporate clients, and patients. The officer ensures that patients receive services according to their coverage while maintaining proper documentation, approvals, billing, and claims processing.
Responsibilities
Manage communication and relationships with HMOs and corporate clients.
Verify patients’ HMO eligibility and coverage.
Process pre-authorizations and approval codes.
Prepare and submit HMO bills and claims.
Follow up on outstanding claims and payments.
Maintain accurate HMO records and documentation.
Attend to HMO-related patient enquiries and complaints.
Liaise with hospital departments to ensure smooth HMO operations.
Requirements
HND/Bachelor’s Degree in a relevant field.
2–4 years’ experience in HMO, hospital administration, or medical billing.
Good communication, documentation, and computer skills.
Knowledge of HMO portals and claims processing.