HMO Officer

Westcare Specialist Hospital is recruiting an HMO Officer at its facility in Egbeda, Lagos State. This full-time healthcare administration role manages Health Maintenance Organization (HMO) operational workflows, portal approval codes, pre-authorizations, claims billing, and partner relations.

Key Responsibilities

• Portal Approvals & Pre-authorizations: Verify patient eligibility, input service requests on HMO portals, and secure approval codes for clinical procedures.

• Claims Billing & Reimbursements: Prepare billings for HMO and corporate retainership patients, track claims, and follow up to secure prompt reimbursements.

• HMO & Client Liaison: Serve as the primary intermediary between the hospital, HMO representatives, and patients regarding coverage, exclusions, and authorizations.

• Documentation & Compliance: Maintain records of approvals, claims, and correspondence while ensuring compliance with hospital policies and HMO guidelines.

Requirements & Qualifications

• Core Competencies: HMO portal management, pre-authorization workflows, claims reconciliation, patient advisory, and healthcare documentation.

• Key Attributes: Attention to detail, clear written and verbal communication, and the ability to operate effectively in a fast-paced hospital setting.

• Geographic Proximity: Applicants must reside within Egbeda or neighboring areas in Lagos State.