JOB DESCRIPTION FOR INSURANCE OFFICER

DUTY STATION:                  Lifelink Hospital, Lifelink Medical Centre

DEPARTMENT:                    Insurance

POSITION:                            Insurance Billing Officer

REPORTS TO:                       Head of Insurance Desk

INTERFACES WITH:            General Manager, Human Resource Manager, Clinical Coordinator and team leaders from other departments

OVERALL PURPOSE

Responsible for receiving, identifying, vetting, verifying and taking all insurance clients through the relevant checks at the point of giving service, ensuring that services offered are within the patient’s limits of cover and bridging all gaps that will otherwise lead to loss of funds by the institution.

JOB REQUIREMENTS

• Minimum of Diploma in Clinical Medicine, Nursing from a recognized OR Bachelor’s Degree in Business Administration or related courses from a recognized institution
• Minimum of 2 years’ experience as an Insurance Officer or in a similar role

CORE COMPETENCIES

• Written and oral communication
• Proficiency in MS Office
• Good Interpersonal skills
• Good Customer care skills
• Observant and detail oriented
• Ability to work under pressure

KEY RESPONSIBILITIES

VETTING

• Ensure patients are covered for services being offered through checking fingerprints, card validity and card ownership.
• Ensures patients are treated within their limits of cover
• Ensures that we do not treat expired/ineligible members.

PRE-AUTH SEEKING

• Ensure you to seek authorization for procedures, admission, ambulance pickups/drops before the service is provided or given to the patient.
• Ensures documented authorizations from all insurance partners through emails or handwritten letters.
• Responsible for attaching approvals on claims before submission to the claims office in Accounts.

CUSTOMER SERVICE/CARE

• Insurance Billing Officer has the responsibility of ensuring that insurance patients are well received, are given all the necessary information relating to their treatment, cover and are smoothly taken through the system (hospital) with minimum setbacks.
• Ensuring good customer care by all team members

BILLING/SMARTING/TRACKSOLING

• All claims are to be billed using the different billing systems i.e. Tracksol, Smart, AAR, Sancare etc.
• For all claims billed off system of reimbursement should be sent and the authorizing person indicated.

CHECKING CLAIM FORMS

One has to go through the claim forms and see if they were properly billed and if they were fully filled and finalized as follows:

• Claims date
• Employee company /employer
• Employee name
• Patient phone number
• Diagnosis
• Key symptoms
• Proof of authorizations attached
• Services itemized and each billed individually
• Claims billed
• Signature: Patient & Doctor

PREPARATION OF CLAIM FORMS

• All claim forms must be posted and excelled for proper record keeping and reconciling.

OTHER RESPONSIBILITIES.

• To always make sure that the insurance workstations are kept clean and tidy.
• Always account for equipment received from the head of department.
• Attend all insurance team meetings as may be communicated by the head/supervisors.
• Any other duties may be assigned by the supervisors.

KEY RESULT AREAS

• Accurate billing in HMIS Systems, SMART & claim forms
• Ability to meet timelines and deadlines
• Claims tracking & accountability
• Process compliance
• Pre-authorization
• Relationship management

LifeLink Medical Centre/Hospital Job Description for Internal Auditor

DUTY STATION       : Lifelink Hospital & Medical Centre

DEPARTMENT         : Internal Audit

POSITION                 : Internal Auditor

REPORTS TO            : Medical Director

INTERFACES WITH : Senior Management team and Heads of Departments.

JOB REQUIREMENTS

• Bachelor’s degree in finance, Accounting, Commerce or related discipline from a recognized university.
• Professional accounting qualification completed (ACCA, CPA)
• Certification in any of the following: Certified Internal Auditor (CIA) or Certified Information System Auditor (CISA) will be an added advantage
• Full membership of the Institute of Certified Public Accountants of Uganda (ICPAU)
• A minimum of 5 years’ experience of internal or external audit with a reputable organization of which at least 3 years must be as Manager or at a Supervisory level;

Experience in auditing medical facilities is desired. Working exposure with a reputable audit firm will be added advantage

CORE COMPETENCIES

• Broad knowledge and understanding of current internal audit legislation with the ability to maintain up to date knowledge and share developments with management.
• Exposure and experience using and implementing audit procedures, including planning, techniques, test and sampling methods.
• Strong knowledge of finance and financial and management accounting
• Knowledge of computerized accounting and audit record keeping systems
• Knowledge of the principles, procedures and practices of accounting, financial records and transactions.
• Thorough understanding of auditing standards, audit procedures, including risk driven audit planning techniques and methods
• Ability to accurately prepare audit findings reports for presentation to the board and management
• Risk identification, assessment and prioritization
• Ability to demonstrate and maintain effective working relationships both internally and externally.
• Ability to achieve an appropriate balance between the independence of the internal auditor’s role with the need to work collaboratively with management for the betterment of the organization.
• Excellent verbal, written and presentation skills
• An excellent communicator, able to provide technical support in a strategic and collaborative manner
• Ability to work under minimum supervision (work autonomously, plan and prioritize own workload)
• Good analytical skills and attention to detail
• Demonstrate excellent interpersonal communication skills, particularly in communicating technical information to a non-technical audience.
• Possess strong coaching skills.
• Concern for Quality and Standards
• High level of Integrity
• Good time management
• Ability to apply sound judgement, think creatively and find effective solutions to complex problems.

• Ability to work under minimum supervision (work autonomously, plan and prioritize own workload)

SPECIFIC JOB RESPONSIBILITIES

Strategic Direction

• To provide strategic audit planning to LifeLink Management
• To ensure that the internal control systems are evaluated for effectiveness on a continuous basis

Stakeholder Management

• Assess managements and Board’s level of compliance with various contracts/ agreements; and LifeLink’s policies and procedures.

Process Management

• Make recommendations on the systems, processes, operations and procedures reviewed; follow up agreed actions with management.
• Conduct regular follow up of all open internal and external audit findings to ensure implementation by LifeLink management.
• Draft audit work plans and programs; and discuss with the Board and Medical Director in preparation for audits that span all major LifeLink business processes.
• Conduct value for money audits at all Lifelink facilities. Provide recommendations on how economy, effectiveness and efficiency can be improved for better use of resources.
• Assess the entity’s IT Systems including the design and operating effectiveness of the automated, IT dependent manual controls and the effectiveness of the IT General Controls.
• Conduct financial, regulatory, operational reviews and compliance testing of policies and procedures to establish reliability and integrity of financial and operating information.
• Prepare and retain comprehensive audit working papers for all key audit and compliance processes.
• Prepare and submit timely Internal Audit reports to the LifeLink Board highlighting work done, findings and relevant recommendations.
• Investigate occurrences of indiscipline, fraud, embezzlement, waste and bring such occurrences to the attention of the Board.

Support To Staff & Other Managers

• Work with the management team to incorporate capacity building for staff in audit processes when gaps in compliance are identified.

Risk Management

• Analyze risks in relation to each process reviewed and test the effectiveness of the control design and whether the controls are operating effectively.
• Advise and guide the directors on areas that require risk management and control (participate in generating and maintaining an updated risk register

Compliance

• Assist all departments to ensure compliance with LifeLink policies and procedures
• Ensure that all LifeLink policies and procedures are in compliance with relevant legislation

Communication And Relations

• Keep the Directors aware of all key audit developments.
• Maintain healthy relationships with management, staff and stakeholders.
• Facilitate top-down communication with the purpose of implementation of Life Link audit strategies and bottom-up communication with the purpose of informing strategy.

Reporting

• Management reports on internal controls
• Monthly internal audit reports
• Prepare operational and risk assessment reports for management analysis.
• Monthly update on Internal Audit Plan
• Monthly update on internal audit activities
• Monthly Audit function performance reports
• Quarterly Audit Goals
• Up to date Risk Register
• Operational Budgets
• Internal Controls and SOPs Manual
• Internal Audit Manual- Updated

• Incident reports (Audit function)

LifeLink Hospital Theatre Nurse Job Description

DUTY STATION       : Lifelink Hospital

DEPARTMENT         : Theater

POSITION                 : Theater Nurse

REPORTS TO            : Head of Theatre

INTERFACES WITH : Clinical Coordinator and Team Leaders from other departments

JOB REQUIREMENTS

• Diploma in Comprehensive Nursing with progressive perioperative services experience or perioperative nursing management experience with increasing level of administrative responsibility and authority.
• Experience: 3 years and more
• Licensure and/or Certification Required- Certificate from the nurses and midwives’ council.

CORE COMPETENCIES

• Excellent Verbal and Written Skills,
• Good leadership skills and problem-solving skills
• Extensive medical knowledge and be able to use specialized medical equipment and computer software.
• Adhere to dress code, appearance is neat and clean. Wear identification while on duty.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Maintain regulatory requirements, including all Ministry of health, and local regulations.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and organize departmental meetings.
• Strong organizational and interpersonal skills
• Ability to determine appropriate course of action in more complex situations
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude.
• Ability to manage multiple and simultaneous responsibilities and to prioritize work schedules

Physical Requirements and Environmental Conditions

• Physically demanding, high-stress environment
• Exposure to blood and body fluids, communicable diseases, chemicals, radiation, and repetitive motions
• Full range of body motion including handling and lifting patients.
• Standing and walking for extensive periods of time
• Corrected vision and hearing to within normal range
• Working irregular hours including after hours

SPECIFIC JOB RESPONSIBILITIES

• Promotes the mission, vision, and values of the organization.
•  Oversees management of perioperative services operationally and fiscally.
• Creates and conveys the mission and vision of peri-operative services with the assistance of the management team.
• Verifies that peri-operative staff provide safe and effective patient-centered care in perioperative services.
• Assists peri-operative staff in evaluating practice and creating strategies for further improvement.
•  Verifies that educational resources are available for perioperative services personnel and holds personnel accountable for compliance with established standards.
• Coordinates, facilitates, and manages change within perioperative services and the health care institution.
• Demonstrates effective communication, consultation, negotiation, and collaboration skills with members of the perioperative team and other stakeholders.
• Maintain effective communication with patient families and carers, all members of the multidisciplinary team to ensure smooth progression of each theatre list to ensure safe and effective patient outcomes.
• Collects and analyzes data related to quality or performance improvement projects that apply to perioperative services.
• Uses effective conflict resolution techniques.
• Evaluates perioperative personnel performance.
• Interviews for perioperative personnel selection.
• Assists perioperative personnel in verifying that appropriate personnel, equipment, and supplies are available.
• Verifies departmental compliance with organizational policies and procedures and regulatory and accreditation standards.
• Provides guidance, support, and constructive feedback to perioperative personnel team members and other team members as appropriate.
• Assesses and responds appropriately to life link hospital organizational culture.
• Pursues professional growth by sharing knowledge, attending, and being involved in professional organizations.
• Acts as a patient advocate and maintains privacy and confidentiality of all appropriate information.
• Demonstrate a sound knowledge of infection control principles and adhere to departmental and area policies in regard to infection control.
• Ensure that the environment is clean and tidy to include walls, floor, coaches and linen before and after any procedure and ensure staff Maintain aseptic technique in all procedures.
• Ensure sterility of instruments and packs are autoclaved.
• Demonstrate awareness and compliance with legal and ethical aspects of a theater nurse.
• Complete all documentation in accordance with Ministry of Health and local policies.
• Maintain accountability for actions in the delivery of nursing care in the client’s operative environment.
• Ensure theater staff maintain and build trust, protect and preserve confidential information.
• Actively participate in ongoing personal and professional development to ensure continuing competency to implement evidence-based practice of current clinical procedures.
• Assist and directly supervise the rest of the theater nurses in providing nursing care.
• Ensure proper use of materials and solutions sparingly without compromising the care from the teams.
• Develops, implements, and maintains theater nursing procedures and practices (Standard Operating Procedures).
• Works closely with hospital staff, surgeons, anesthetist/anesthesiologists and other theater staff to ensure the highest standards of quality and service are maintained.
• Creates functional strategies and specific objectives for the theater and develops budgets/policies/procedures to support the theater department together with the hospital anesthesiologist.
• Assist during surgeries scheduled on the days while on duty and when called upon.
• Identify gaps and training needs of all theater staff and train them as per needs identified.
• To draft the duty roster for theater nurse.
• Participate in designing theater service policies/Standard Operating Procedures for Life link Hospital.
• Responsible for maintaining the integrity of Hospital operations within the theater function, quality assurance, safe environment and infection control standards
• Manage patients with confidentiality and adherence to professional code of conduct, hospital policies and procedures and best practices in health care.
• Performs administrative duties as required such as registration of birth notifications, deaths and other required reports, case management, records maintenance to maintain quality assurance.
• Contributes to Life link Hospital institutional knowledge by staying current on issues in the health care field and sharing knowledge as required with other staff.
• Confirm that there is adequate refill of supplies.
• Ensure handover of the theater supplies, drugs and equipment is done by all staff.
• Submit Monthly reports and any other special reports as requested by the supervisor.
• Perform any other duties assigned to you.

Lifelink Pharmacy Dispenser Job Description

DUTY STATION         : Lifelink Pharmacy

DEPARTMENT           : Pharmacy

POSITION                   : Pharmacy Dispenser

REPORTS TO              : Pharmacist

INTERFACES WITH   : Clinical Coordinator, General Manager, Hospital Operations Manager, Team Leaders from other departments

JOB REQUIREMENTS

• Diploma, or a certificate from a recognized institution
• At least 2 years of experience in a similar role.
• Licensure and/or Certification:  Registration certificate from the Nurses and Midwives Council or from Allied Health Professionals Council, with an impressive track record.
• Must have a valid Annual Practicing License

CORE COMPETENCES

• Excellent Verbal and Written Skills, problem solving skills, good medical knowledge, and able to use basic computer software.
• Behavioral Competencies:
• Excellent organizational skills required
• Ability to perform well under pressure
• Excellent interpersonal skills using the team work concept
• Careful and analytical approach to work
• Sympathetic, supportive and professional approach to patients
• Able to prioritize
• Able to learn independently
• Detail oriented
• Possess physical stamina
• Creative and proactive
• High degree of integrity
• Good phone etiquette and public relations

JOB RESPONSIBILITIES.

Key Responsibility: To dispense drugs as required by patients.

• Assessing drug supplies and medical needs of the pharmacy
• Making daily pharmacy requisitions for drugs from main store which are running out of stock or which are required by patients or other departments served by pharmacy.
• Receiving stock into the pharmacy by ensuring the right drugs, quality, quantity, and batch are received in addition to other requirements as per national drug authority requirement.
• Ensuring drugs are correctly arranged on shelves according to their classification and FEFO
• Daily dusting of drugs, shelves and ensuring a clean working environment.
• Ensuring a daily record of temperature for the cold chain items.
• Filling of patient prescriptions both insurance and outpatients. Proper filing of insurance forms and ensuring the right drug is given to the right insurance company.
• Giving right drug information to patients while dispensing of drugs for example, side effects, contraindications, frequency on when to take medications, precautions to be taken and any relevant information regarding the drugs taken.
• Ensuring all drugs sold out are posted in the system and transfers posted to the different departments served.
• Ensuring drug expiries are checked on a regular basis and every time a prescription is filled for a patient. Items with short expiry to be sorted out and dispensed first.
• Make a daily report on returned drug items, these must be in good shape and returned in the system in case they are not taken.
• Monthly pharmacy stock taking.
• Monitoring room temperature in pharmacy and making adjustments as required.
• Record any adverse effects reported about a drug and report to the pharmacist.
• Ensure drugs and medical supplies tally between the system stock balance and physical balance at all times.
• Able to receive and find solutions to patients’ feedback
• Be involved in pricing of products and drugs
• Participate in drafting timetable for the pharmacy shifts.
• Share pharmacy reports.