Health Financing Assistant

MSI Reproductive Choices Kenya is an NGO registered in Kenya, serving as a local implementing partner for MSI Reproductive Choices, a UK charity. The organization provides quality sexual and reproductive healthcare, family planning, and other women's health services to vulnerable women, aiming to ensure choice in childbearing and reduce unsafe abortion-related deaths.

The Health Financing Assistant at MSI Reproductive Choices Kenya is a short-term position crucial for ensuring precise and timely reconciliation of insurance payments and statements. The role involves actively managing insurance receivables, meticulously verifying payment allocations, and promptly resolving any discrepancies. The assistant will also be responsible for maintaining current insurance statements to facilitate effective revenue realization and accurate financial reporting. This position directly contributes to the organization's overarching goal of empowering every Kenyan with reproductive choices. The successful candidate is expected to embody MSI Reproductive Choices' core values: being Mission Driven, Client-Centered, Accountable, Courageous, Resilient, and Inclusive.

1. Review claim forms across all centers for accuracy, completeness, and compliance with insurer requirements.
2. Verify supporting documents, approvals, and patient details before claim submission.
3. Scan, organize, and archive claim forms and supporting documents for easy retrieval and audit.
4. Submit claims to insurance providers for payment processing.
5. Reconcile submitted claims against services billed in the Electronic Health Record (EHR) and insurance billing systems to identify discrepancies.
6. Verify billing accuracy, including services offered, charges, and contractual rates.
7. Follow up on discrepancies and outstanding submissions to minimize revenue loss.
8. Track claims through various insurance portals such as Smart, Smart EDI, LCT, Slade, OML SharePoint Portal, Mtiba, Starconnect, and Henner/SHA portal.
9. Update claims vetting and submission statuses in the EHR and maintain accurate records of outstanding claims.
10. Identify and escalate system challenges affecting claims processing and submission.
11. Verify that billed prices align with agreed insurance contracts and approved tariffs.
12. Ensure all required authorizations, approvals, and supporting documents are attached to claims.
13. Monitor compliance with insurer requirements and internal procedures, addressing identified gaps with relevant teams.
14. Support centers with queries related to client eligibility, billing, insurance approvals, and claims documentation.
15. Liaise with center teams, IT, and other stakeholders to resolve insurance billing system challenges and operational issues.
16. Communicate changes in insurance requirements and reinforce adherence to established processes.
17. Prepare regular reports on claims submitted, outstanding items, billing discrepancies, and compliance gaps.
18. Follow up on corrective actions and support improvements in claims accuracy, submission efficiency, and reimbursement.
19. Maintain proper documentation to support audits, reconciliation, and management reporting.
20. Provide operational support to the existing Health Financing Assistant (HFA) as they cover the Health Financing Officer’s responsibilities during maternity leave.
21. Assist with day-to-day insurance operations, claims management, and stakeholder coordination to ensure continuity of service delivery.
22. Support corporate business development initiatives in collaboration with the existing HFA to expand and maintain insurance business across all centers.
23. Coordinate with insurance providers and center teams to address operational challenges and strengthen service delivery.

1. Hold a Diploma or Bachelor’s degree in Finance, Accounting, Business Administration, or a related field.
2. Possess at least 3 years of experience in claims management within a reputable health organization.
3. Have a minimum of 2 years of experience in office administration or accounting, preferably in a hospital setting.
4. Demonstrate strong knowledge in claims management.
5. Exhibit advanced proficiency in Microsoft Excel, including the use of formulas, pivot tables, lookups, and data analysis tools for financial reconciliation and reporting.
6. Show high attention to detail and the ability to follow through tasks to completion.
7. Possess good organization and prioritization skills.
8. Be able to work with minimal supervision and demonstrate initiative.
9. Have strong analytical skills.
10. Possess excellent communication and coordination abilities.
11. Prior experience in insurance or healthcare finance is considered an added advantage.