HMO Officer

St. Dominic Catholic Hospital is a 64-bed hospital located in Ogungbade off New Ife road in Ibadan. St. Dominic Catholic Hospital is the vision of the Dominican Sisters of St. Catherine of Siena (Italy). We offer various medical services such as: General medicine, internal medicine, O & G, Laboratory, and Radiology, to mention just a few. The hospital is run in collaboration with foreign partners. We are registered and licensed by the Corporate Affairs Commission and the Ministry of Health. Also, we are accredited by the NHIS as both primary and secondary health care providers. We are recruiting to fill the position below:

Job Title: HMO Officer

Location: Ibadan, Oyo

Employment Type: Full-time 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.