HMO Officer

AI summary

St. Dominic Catholic Hospital is hiring an HMO Officer in Ibadan, Oyo. The role involves managing HMO operations, verifying patient eligibility, processing claims, and liaising with HMOs. Candidates with HND/Bachelor's in health administration or related fields and 2-3 years HMO experience are encouraged to apply.

• Manage all HMO-related operations including eligibility, authorization, and claims processing.
• Liaise with HMOs such as AXA Mansard, Hygeia, Redcare, and Avon.
• Salary: N90,000 - N130,000 per month.
• Full-time position in Ibadan, Oyo.
• HND/Bachelor's degree and 2-3 years HMO experience required.

Original source description

HMO Officer Job at St. Dominic Catholic Hospital | Jobgurus Toggle navigation Jobs Job Seekers Aptitude Test Scholarships Register Sign in Employer? Post a Job CLICK HERE TO JOIN OUR WHATSAPP CHANNEL HMO Officer Job at St. Dominic Catholic Hospital St. Dominic Catholic Hospital is a 64-bed hospital located in Ogungbade off New Ife road in Ibadan. St. Dominic Catholic Hospital is the vision of the Dominican Sisters of St. Catherine of Siena (Italy). We offer various medical services such as: General medicine, internal medicine, O & G, Laboratory, and Radiology, to mention just a few. The hospital is run in collaboration with foreign partners. We are registered and licensed by the Corporate Affairs Commission and the Ministry of Health. Also, we are accredited by the NHIS as both primary and secondary health care providers. We are recruiting to fill the position below: Job Position: HMO Officer Job Location: Ibadan, Oyo Employment Type: Full-time Job Purpose The HMO Officer is responsible for managing all Health Maintenance Organization related operations in the hospital. The role ensures smooth enrollment, authorization, claims processing, and relationship management between the hospital, HMOs, and patients to guarantee prompt service delivery and revenue collection. Responsibilities: Patient Services & Eligibility: Verify HMO patient eligibility and coverage using HMO portals before consultation/admission. Ensure proper registration and issuance of authorization codes for all HMO enrollees. Attend to HMO patients’ complaints and guide them on benefits, co-pay, and exclusions. Liaise with clinicians to ensure treatment plans fall within HMO package guidelines. Authorization & Claims Management: Obtain pre-authorization for consultations, admissions, surgeries, and referrals within stipulated time. Prepare, collate, and submit claims to respective HMOs with complete supporting documents. Follow up on outstanding claims and ensure timely payment/reimbursement by HMOs. Track and reconcile HMO payments and deductions with hospital finance. HMO Relations & Compliance: Serve as the primary liaison between the hospital and all partner HMOs: AXA Mansard, Hygeia, Redcare, Avon, etc. Ensure the hospital complies with NHIA/HMO guidelines, service level agreements, and tariff structures. Attend HMO meetings, trainings, and audits on behalf of the hospital. Communicate policy changes, new tariffs, and benefit updates to clinical staff. Reporting & Documentation Maintain an accurate database of all HMO patients, authorizations, and claims. Prepare weekly/monthly reports on HMO patient volume, revenue, outstanding claims, and challenges. Ensure proper filing and archiving of all HMO documents for audit purposes. Requirements: Education: HND/Bachelor’s Degree in Health Administration, finance, Nursing, Public Health, or related fields. Experience: 2-3 years of experience: in an HMO, Hospital Corporate Services, or Insurance department. Knowledge: Good understanding of NHIA guidelines, HMO operations, and hospital billing processes. Required Skills and Competencies: Excellent communication and interpersonal skills Proficiency in Microsoft Excel, Word, and HMO portals Strong negotiation and problem-solving skills Attention to detail and good record-keeping Ability to work under pressure and meet deadlines Professionalism and patient-centered approach. Salary N90,000 - N130,000 per month. Method of Application Interested and qualified candidates should send their CV and Application Letter to: [email protected] using the Job Position as the subject of the email. 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