Billing Quality Officer - Mukono job at C-Care

Job Summary

The Billing Quality Officer ensures that every service billed is properly documented, priced, and justified in line with hospital standards, payer contracts, and best clinical practices. This role bridges the gap between the clinical, billing, and finance teams—reducing claim rejections, improving billing turnaround times, and enhancing the hospital’s revenue assurance framework.

Job Details

1. Bill Verification & Quality Review

• Review and validate all inpatient bills for completeness, clinical justification, and compliance with approved rates and payer contracts.
• Verify that procedures, medications, and consumables captured in the system align with patient charts, physician orders, and nursing documentation.
• Detect and correct billing anomalies such as unbilled services, duplicate entries, or inappropriate charges before release.
• Maintain a structured daily bill review checklist and ensure documentation is traceable and auditable.

2. Clinical & Billing Coordination

• Serve as the primary liaison between the billing officers, clinicians, and nurses, ensuring all clinical interventions are properly documented and billed.
• Clarify ambiguities in clinical notes, procedures, or consumable usage in collaboration with treating clinicians and ward managers.
• Provide on-the-spot mentorship to billing officers and clinical teams to strengthen documentation and billing accuracy.
• Participate in ward rounds or patient file reviews where needed to ensure consistency between care rendered and charges billed.

3. Credit Memo & Adjustment Review

• Review and recommend approval for credit memos and billing adjustments based on verified documentation and justified clinical or administrative reasons.
• Ensure that all adjustments are properly approved in accordance with the hospital’s billing and credit policies.
• Maintain a register of recurring billing issues and propose preventive measures to management.

4. Discharge Verification & Control

• Confirm patient discharge readiness from a billing and documentation perspective before final clearance.
• Verify that all procedures, investigations, and pharmacy issues are billed and reconciled before patient exit.
• Coordinate with nursing and finance units to ensure final bills are released only after completeness verification.

5. Claims Submission & Quality Oversight

• Supervise submission of bills to the vetting team or insurance portals ensuring timeliness, accuracy, and required attachments.
• Track rejected or queried claims, analyze root causes (clinical, documentation, or pricing), and recommend corrective actions.
• Maintain a claims quality log and share insights for continuous improvement in billing and documentation practices.
• Ensure all billing processes adhere to hospital policies, payer requirements, and regulatory guidelines.
• Prepare and present periodic reports highlighting the Billing error rates and trends and Clinical documentation gaps in Claim rejection analysis and recovery status
• Participate in internal audits, quality improvement meetings, and policy review sessions.

6. Compliance, Reporting & Continuous Improvement

• Ensure all billing processes adhere to hospital policies, payer requirements, and regulatory guidelines.
• Prepare and present periodic reports highlighting: Billing error rates and trends
• Clinical documentation gaps in Claim rejection analysis and recovery status
• Participate in internal audits, quality improvement meetings, and policy review sessions

Requirements

• Registered Nurse (RN) with a valid practicing license from the Uganda Nurses and Midwives Council.
• Bachelor’s degree in nursing, Health Administration, or related clinical discipline (Any further training in Finance/Business background is an added advantage).
• Minimum of 3 years’ experience in hospital billing, health insurance vetting, or revenue assurance functions.

About Company

C-Care is a leading provider of medical care in Mauritius, Uganda, and Madagascar. From our world-class facilities to our cutting-edge treatments, we strive for excellence and compassion in everything we do at C-Care, from the care we provide to the way we treat our patients and their families.

• Review and validate all inpatient bills for completeness, clinical justification, and compliance with approved rates and payer contracts.
• Verify that procedures, medications, and consumables captured in the system align with patient charts, physician orders, and nursing documentation.
• Detect and correct billing anomalies such as unbilled services, duplicate entries, or inappropriate charges before release.
• Maintain a structured daily bill review checklist and ensure documentation is traceable and auditable.
• Serve as the primary liaison between the billing officers, clinicians, and nurses, ensuring all clinical interventions are properly documented and billed.
• Clarify ambiguities in clinical notes, procedures, or consumable usage in collaboration with treating clinicians and ward managers.
• Provide on-the-spot mentorship to billing officers and clinical teams to strengthen documentation and billing accuracy.
• Participate in ward rounds or patient file reviews where needed to ensure consistency between care rendered and charges billed.
• Review and recommend approval for credit memos and billing adjustments based on verified documentation and justified clinical or administrative reasons.
• Ensure that all adjustments are properly approved in accordance with the hospital’s billing and credit policies.
• Maintain a register of recurring billing issues and propose preventive measures to management.
• Confirm patient discharge readiness from a billing and documentation perspective before final clearance.
• Verify that all procedures, investigations, and pharmacy issues are billed and reconciled before patient exit.
• Coordinate with nursing and finance units to ensure final bills are released only after completeness verification.
• Supervise submission of bills to the vetting team or insurance portals ensuring timeliness, accuracy, and required attachments.
• Track rejected or queried claims, analyze root causes (clinical, documentation, or pricing), and recommend corrective actions.
• Maintain a claims quality log and share insights for continuous improvement in billing and documentation practices.
• Ensure all billing processes adhere to hospital policies, payer requirements, and regulatory guidelines.
• Prepare and present periodic reports highlighting the Billing error rates and trends and Clinical documentation gaps in Claim rejection analysis and recovery status
• Participate in internal audits, quality improvement meetings, and policy review sessions.
• Ensure all billing processes adhere to hospital policies, payer requirements, and regulatory guidelines.
• Prepare and present periodic reports highlighting: Billing error rates and trends
• Clinical documentation gaps in Claim rejection analysis and recovery status
• Participate in internal audits, quality improvement meetings, and policy review sessions

• Billing quality review
• Clinical and billing coordination
• Credit memo and adjustment review
• Discharge verification and control
• Claims submission and quality oversight
• Compliance, reporting, and continuous improvement
• Mentorship
• Auditing
• Data analysis
• Problem-solving
• Communication
• Attention to detail

• Registered Nurse (RN) with a valid practicing license from the Uganda Nurses and Midwives Council.
• Bachelor’s degree in nursing, Health Administration, or related clinical discipline.
• Any further training in Finance/Business background is an added advantage.