HMO Officer

HMO Officer at St Dominic Catholic Hospital

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.

HMO Officer

• Job Type Full Time
• Qualification BA/BSc/HND
• Experience 1 - 5 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: 1-5years’ 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.

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