Reconciliation Officer at Avenue Healthcare

Job Objective/Purpose

Confirmation of actual debtors’ receipts, obtaining remittances and timely allocation of the same.

Key Responsibilities

• Reconcile debtors’ remittances against submitted claims to ensure accuracy, completeness, and proper posting of revenues.
• Prepare and submit debtors claims with all required supporting documentation, including invoices, pre-authorizations, and medical reports, for dispute resolution purposes.
• Investigate, analyse, and resolve variances between billed revenues and actual cash inflows.
• Prepare reconciliation sign-off documents with debtors upon successful completion of the reconciliation process for agreed financial periods.
• Re-document and resubmit disputed claims to debtors within stipulated timelines and monitor acknowledgment of receipt.
• Track debtors’ claim at every stage of the revenue cycle to ensure timely processing and settlement.
• Follow up on signed-off reconciled amounts to ensure prompt payment.
• Liaise with insurance companies and third-party administrators to resolve disputed, rejected, or pending claims.
• Maintain strong working relationships with debtors’ representatives to facilitate faster resolution of claims.
• Ensure all claims comply with hospital policies, insurance requirements, and relevant regulatory standards.
• Monitor, analyse, and report trends in claim rejections or denials, and recommend corrective and preventive measures.
• Prepare periodic reports on claims submitted, amounts recovered, outstanding balances, and rejection or denial trends.
• Collaborate with clinical, billing, and administrative teams to ensure accurate patient information and complete claim documentation.
• Train and sensitize staff on proper documentation and billing practices to minimize claim rejections.
• Recommend and support process improvements aimed at reducing turnaround times and enhancing claim recovery efficiency.

Person Specification

• Bachelor’s degree in a business-related field.
• CPA 2.
• Minimum 2 years experience.
• Attention to detail.
• Excellent interpersonal skills and a team player.