Billing Quality Officer

Description
C-Care Uganda is hiring a Billing Quality Officer that 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.

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.
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.
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.
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.
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.
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
 

Qualifications, Skills and Experience:

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.
 

How to Apply:

All suitably qualified and Interested applicants should apply online at the link below.

https://c-care.seamlesshiring.com/job/view/9551

NB: Only shortlisted candidates will be contacted.