Location Marie Stopes Hospital
No. of Direct Reports N/A
Reporting to Hospital Operations Coordinator
Budget Responsibilities (Y/N) N

Marie Stopes Uganda is an NGO registered in Uganda. We are affiliated to Marie Stopes International.  Together we deliver post abortion care, quality sexual and reproductive health care and family planning to millions of the world's poorest and most vulnerable women. We want to make sure that women have a choice when it comes to having children and that death by unsafe abortion is reduced.
The primary responsibility of this role is to further our Goal: THE PREVENTION OF UNWANTED BIRTHS and its mission of ensuring the individual’s right to: CHILDREN BY CHOICE NOT CHANCE

The Role
Reporting to the Operations Coordinator, the Hospital Medical Claims officer oversees and coordinates all activities related to medical insurance claims, ensuring accurate and timely submission, follow-up, and settlement of claims. The role involves supervising the claims processing team, managing relationships with insurance providers, resolving claim denials or disputes, and ensuring compliance with hospital policies and payer regulations. The Claims officer plays a key role in optimizing hospital revenue and maintaining positive insurer relations.

Key Responsibilities

• Claims vetting – Conduct daily claims and system audits to: o ensure that all clients who come to the hospital are billed correctly.
  • ensure that right entries are entered into E H R and the 3rd party billing systems.
  • Ensure that the Day and Night invoices are vetted on a daily basis. o Review claims for completeness, accuracy, and compliance with insurance and regulatory requirements.
• Invoice handling: o Review interim bills daily and discharges and ensure creativeness of bills that meet the standards of insurance and cash patient.
  • Oversee billing, pricing and insurance claims management.
• Invoice submission and reconciliation. o Supervise and coordinate daily operations of the claims department, including claim preparation, submission, follow-up, and reconciliation.
  • Ensure all claims are submitted accurately and within payer timelines to avoid rejections or delays.
  • Investigate and resolve denied, underpaid, or delayed claims, coordinate appeals and resubmissions as necessary.
  • Liaise with insurance companies, patients, and internal hospital departments to resolve claim issues.
• Liaison with Insurance Companies /stakeholder management– o Review preauthorization forms for completeness/ justification and follow up on insurance response o To make sure that all communication from invoicing companies is disseminated to the CLOs and all required parties in a timely manner e.g. new updated lists, off list and contract updates.
  • Follow up on any queries as regards guarantees of payment, authorization requests and provide any other clarity required from insurance companies as required.
  • Meeting attendance and representation
• Reporting: o Will provide a daily status report on service income split between posted invoices, pending invoices for different insurance companies, a status on all non-paid off transactions in E H R and means of resolution
  • A report on variances between E H R, SMART and any other portal that an insurance company uses. o Revenue collection analysis – compare lists EHR BI and actual revenue invoiced
• Orientation and Training: o The Claims Officer shall ensure continuous training for CLOs and any other required personnels on E H R, SMART & insurance companies’ smart systems & will also provide induction and on-boarding for new staff on technical, non-technical, system related skills required for the job at hand.
  • Devise Billing protocols & manuals, ensure alignment and compliance of teams

• Assets Custodianship o Ensure effective custodianship and accountability for all assigned MSUG assets by implementing controls to prevent loss, theft or misuse of assets.

Knowledge, Skills and Attitudes
Qualifications:

• BSc or Diploma as a Clinical Officer or Registered Nurse
• Strong background and prior experience/ exposure to medical claims
• Strong knowledge of healthcare insurance processes, billing systems, and medical terminology.
• Excellent leadership, analytical, and problem-solving skills.
• Strong interpersonal and communication abilities for interacting with insurers, patients, and hospital staff.

Knowledge, Skills/ Experiences, and Abilities 

• Excellent organisational skills and high attention to detail
• Analytical thinking and data interpretation
• Knowledge of healthcare regulations and insurance procedures
• Negotiation and conflict resolution skills
• Confidentiality and ethical conduct
• Demonstrated ability to balance multiple tasks and priorities
• Strong interpersonal skills that include an ability to work in team environment
• Good interpersonal/communication (both oral and written) and time management skills.
• Good working knowledge of Microsoft Office applications (MS Word, Excel, and MS Access)
• Three years of relevant hospital management experience or clinical setting.
• Four years in administration at managerial level.

Personal Attributes
Successful performance at MSI is not simply defined in terms of ‘what’ people achieve but equally is about ‘how’ people go about their jobs and the impact that they have on others. We encourage and expect all team members will demonstrate the following behaviours: 

• Initiative

Thinking ahead and taking action to make the most of opportunities by finding the optimum solution

• Innovative

Thinking creatively and outside of the box so that ideas generated create a positive outcome

• Effective Communication

Communicating through active listening and good questioning techniques, using appropriate body language, ensuring information is clear and concise.

• Responsive

Being responsive to changing priorities and demands

• Working Efficiently

Planning, prioritising and organising work to ensure work is accurate and deadlines are met

• Sharing Information

Sharing information and knowledge whilst maintaining confidentiality

• Focus on Learning.

Taking responsibility for keeping knowledge and skills updated and for seeking opportunities to develop further

• Commitment

Awareness and understanding of goals, vision, and values and how your role impacts on this and going the extra mile to meet role requirements

• Driven

Drive and determination to deliver results

• Accountable

Taking responsibility for appropriate decisions that you make, and the actions and behaviour you demonstrate

• Embracing Change

Openness to embracing change within the organization and being able to adjust plans/activities accordingly

• Motivated

Motivation towards achieving quality results to maximize potential

• Team Player

Working as part of a team by being supportive, flexible and showing respect for each other 

MSI Behaviours and Values
Team Member Behaviours
Work as One MSI

• You contribute, use, and share accurate data and evidence to improve understanding, insight and decision-making across MSI, enabling us to maximize our ability to influence others.
• You share relevant knowledge, expertise, and resources to strengthen teamwork and prevent duplication of effort.
• You actively work as part of a team, providing support and flexibility to colleagues, demonstrating fairness, understanding and respect for all people and cultures.

Show courage, authenticity and integrity. 

• You hold yourself accountable for the decisions you make and the behaviours you demonstrate.
• You are courageous in challenging others and taking appropriate managed risks.

Develop and grow

• You seek feedback to enable greater self-awareness and provide the same to others in a way which inspires them to be even more effective.
• You manage your career development including keeping your knowledge and skills up to date.

Deliver excellence, always

• You strive to consistently meet and exceed expectations, putting clients at the centre of everything, and implement smarter, more efficient ways of performing your role.
• You build and maintain effective long-term working relationships with all stakeholders and are a true MSI ambassador.

Leadership (For Leaders only)

• You inspire individuals and teams, through situational leadership, providing clear direction.
• You seek and provide opportunities which motivate team members, helping to develop skills and potential whilst strengthening our talent and succession pipeline.
• You are aware of emerging developments in our sector, demonstrating strategic insight about our clients and business and encourage this in your team.
• You articulate a vision of the future which inspires and excites others.

MSI Values

• Mission driven: With unwavering commitment, we exist to empower women and men to have children by choice not chance.
• Client centred: We are passionate about our clients and dedicate our efforts to delivering agreed objectives to the highest possible quality.
• Accountable: We are accountable for our actions and take responsibility for everything we do to ensure long term sustainability and increased impact.
• Courageous: We recruit and nurture talented, passionate, and brave people who have the courage to push boundaries, make tough decisions and challenge others in line with our mission.
• Resilient: In challenging situations, we work together and support each other, adapting and learning to find solutions, whatever we’re up against.
• Inclusive: We believe that diversity is a strength. We all play our part in creating a culture where every team member can thrive, feel valued and contribute meaningfully to our mission, and where all our clients feel welcome and supported.

• Claims vetting – Conduct daily claims and system audits to: o ensure that all clients who come to the hospital are billed correctly.
• o ensure that right entries are entered into E H R and the 3rd party billing systems.
• o Ensure that the Day and Night invoices are vetted on a daily basis. o Review claims for completeness, accuracy, and compliance with insurance and regulatory requirements.
• Invoice handling: o Review interim bills daily and discharges and ensure creativeness of bills that meet the standards of insurance and cash patient.
• o Oversee billing, pricing and insurance claims management.
• Invoice submission and reconciliation. o Supervise and coordinate daily operations of the claims department, including claim preparation, submission, follow-up, and reconciliation.
• o Ensure all claims are submitted accurately and within payer timelines to avoid rejections or delays.
• o Investigate and resolve denied, underpaid, or delayed claims, coordinate appeals and resubmissions as necessary.
• o Liaise with insurance companies, patients, and internal hospital departments to resolve claim issues.
• Liaison with Insurance Companies /stakeholder management– o Review preauthorization forms for completeness/ justification and follow up on insurance response
• o To make sure that all communication from invoicing companies is disseminated to the CLOs and all required parties in a timely manner e.g. new updated lists, off list and contract updates.
• o Follow up on any queries as regards guarantees of payment, authorization requests and provide any other clarity required from insurance companies as required.
• o Meeting attendance and representation
• Reporting: o Will provide a daily status report on service income split between posted invoices, pending invoices for different insurance companies, a status on all non-paid off transactions in E H R and means of resolution
• o A report on variances between E H R, SMART and any other portal that an insurance company uses.
• o Revenue collection analysis – compare lists EHR BI and actual revenue invoiced
• Orientation and Training: o The Claims Officer shall ensure continuous training for CLOs and any other required personnels on E H R, SMART & insurance companies’ smart systems & will also provide induction and on-boarding for new staff on technical, non-technical, system related skills required for the job at hand.
• o Devise Billing protocols & manuals, ensure alignment and compliance of teams
• Assets Custodianship o Ensure effective custodianship and accountability for all assigned MSUG assets by implementing controls to prevent loss, theft or misuse of assets.

• Excellent organisational skills and high attention to detail
• Analytical thinking and data interpretation
• Knowledge of healthcare regulations and insurance procedures
• Negotiation and conflict resolution skills
• Confidentiality and ethical conduct
• Demonstrated ability to balance multiple tasks and priorities
• Strong interpersonal skills that include an ability to work in team environment
• Good interpersonal/communication (both oral and written) and time management skills.
• Good working knowledge of Microsoft Office applications (MS Word, Excel, and MS Access)

• BSc or Diploma as a Clinical Officer or Registered Nurse
• Strong background and prior experience/ exposure to medical claims
• Strong knowledge of healthcare insurance processes, billing systems, and medical terminology.
• Excellent leadership, analytical, and problem-solving skills.
• Strong interpersonal and communication abilities for interacting with insurers, patients, and hospital staff.