HMO Officer

AI summary

St Dominic Catholic Hospital in Ibadan, Oyo State, is hiring a full-time HMO Officer to manage HMO-related operations including patient eligibility verification, authorization, claims processing, and liaison with partner HMOs. The role requires an HND or Bachelor's degree and 2-3 years of relevant experience in a hospital, HMO, or insurance setting.

• Full-time role at a 64-bed faith-based hospital in Ibadan
• Manage HMO enrollment, authorization, claims, and payments
• Liaise with partner HMOs including AXA Mansard, Hygeia, Redcare, and Avon
• Requires HND/Bachelor's degree and 2-3 years' experience
• Apply by emailing CV and application letter to adm.sdchib2019@yahoo.com

Original source description

At St Dominic Catholic hospital we foster, promote and practice Catholic and Medical ethics and evidence based medicine. St Dominic Catholic Hospital is a 64 bed Faith base hospital providing both primary and secondary medical services. Read more about this company HMO Officer Job Type Full Time Qualification BA/BSc/HND Experience: 2 - 3 years Location Oyo City Ibadan Job Field Administration / Facilities 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’ 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. Check how your CV aligns with this job Method of Application Interested and qualified candidates should send their CV and Application Letter to: adm.sdchib2019@yahoo.com using the Job Title as the subject of the email. Build your CV for free. Download in different templates.