Benefit Specialist at ADEC Kenya Services EPZ Limited (ADEC Kenya)

• Under the supervision of the supervisor, this role will be responsible for reviewing patient statement returned mail, posting the returned statements appropriately, and managing unbilled claims that need to be posted and rebilled, provided the claim is within one year from the date of review. The ideal candidate will have a strong understanding of medical billing, claims processing, and a commitment to HIPAA compliance.

DUTIES & RESPONSIBILITIES
Responsibilities:

• Review Returned Patient Statements: Process and review patient statement returned mail, ensuring that updated patient information is captured and any issues are resolved; Post the returned statements into the system after verifying addresses and other necessary corrections
• Unbilled Claims Review & Rebilling: Review unbilled claims within the system to ensure proper billing and timely follow-up; Post unbilled claims to the appropriate accounts and prepare them for rebilling if they fall within one year from the date of review; Identify, track, and resolve any issues causing claims to remain unbilled,
• Claims Rebilling: Rebill claims when necessary, ensuring accuracy in claim content and that all required information is included for proper payment; Ensure that all rebilled claims comply with payer guidelines, regulations, and internal billing policies.
• Data Entry & Recordkeeping: Accurately enter and update information in the billing system, ensuring all actions are properly documented; Maintain thorough and accurate records of returned patient statements, unbilled claims, and any follow-up actions taken; Generate and review reports to monitor the status of claims, returned statements, and other AR-related tasks.
• Communication & Support: Provide clear and timely communication with internal teams (Supervisor, Manager) to resolve any issues related to claims, payments, or returned mail.
• Ensures compliance to company rules and regulations, which shall include but not limited to the Employee Code of Discipline, the policies on Quality Management System (QMS), Information Security Management System (ISMS), Environment Health & Safety (EHS), and Environmental Management System (EMS); Data Privacy Act (DPA); and other duties and responsibilities prescribed for all ADEC employees.
• Ensures compliance of all Non-Conformity Corrective Action Preventive Action Concessions (NCAPACs) and all other audit findings within the prescribed period.
• Reports security incidents and/or any identified security weaknesses.
• Performs other tasks that may be assigned from time to time.

JOB REQUIREMENTS

Education    

• College graduate

Experience    

• At least 6 months of experience in medical billing, accounting or cash posting in a provider or facility set-up is an advantage
• Good understanding of medical claims content, billing procedures, and insurance processes.
• Familiarity with unbilled claims, posting procedures, and rebilling processes.
• Ability to navigate billing software
• Excellent attention to detail and organizational skills.
• Ability to work effectively under deadlines and manage multiple tasks.
• Proficiency with MS Office tools, especially Excel and Word.