Key Responsibilities
Insurance/corporate
Pre-authorisation & Authorization Management
- Oversee and review all outpatient pre-authorisation requests
submitted to insurance/corporate companies including Social Health
Authority (SHA), ensuring accuracy, completeness, and timeliness
- Supervise the end-to-end inpatient authorization process from
initial submission through to approval, including management of pending
cases and escalation of disputes
- Maintain up-to-date knowledge of payer policies, SHA protocols, and
benefit schedules to guide the team on correct claim coding and
authorization submission
- Monitor authorization turnaround times and flag delays that may
affect patient care or revenue flow, escalating to clinical or finance
teams as needed
- Liaise directly with insurance/corporate case managers/contacts and
SHA relationship officers to resolve disputes, obtain extensions, and
manage complex or high-cost authorizations
Admissions
Management
- Supervise the admission of all referred patients from external
healthcare facilities, ensuring proper documentation, clinical handover
protocols, and bed allocation are coordinated promptly
- Manage the conversion process for outpatients requiring inpatient
admission, ensuring a seamless transition without disruption to the
patient experience or clinical workflow
- Verify completeness of all admission documentation including
referral letters, patient identification, insurance/corporate eligibility
checks, and deposit or guarantee letters where applicable
- Coordinate with clinical departments, nursing, and housekeeping to
manage bed availability and expected admissions, minimizing patient
waiting times
- Ensure all admissions are captured accurately and in real time on
the Hospital Management Information System (HMIS)
Discharge
Coordination
- Oversee the discharge process to ensure timely clearance of
patients, including final billing reconciliation, insurance/corporate
sign-off, and collection of outstanding patient balances
- Coordinate with nursing, pharmacy, and finance teams to resolve
pre-discharge holds and confirm discharge summaries are complete before
patient departure
- Monitor average length-of-stay data and work with clinical teams to
reduce avoidable delays in discharge
Team
Leadership & Department Oversight
- Directly supervise and performance-manage all staff within the
Admissions & Discharges Office across all shifts, including weekends
and public holidays
- Prepare duty rosters ensuring adequate coverage at all times; manage
leave, absenteeism, and overtime within approved thresholds
- Identify training needs and facilitate on-the-job coaching and
structured development to maintain team competency and service quality
- Conduct regular team briefings and performance reviews, documenting
outcomes and escalating HR matters as appropriate
- Foster a culture of accuracy, accountability, and patient-centred
service
Metrics,
Reporting & Analytics
- Track and report on key performance indicators including
pre-authorisation approval rates, denial/rejection rates, admissions
volumes, OP-to-IP conversion rates, and discharge turnaround times
- Prepare daily, weekly, and monthly operational reports for the Head
of Patient Services and senior management
- Identify trends and recommend operational or policy changes to
improve authorization approval rates and reduce admission delays
Process
Improvement & Compliance
- Implement process changes to reduce authorization errors and shorten
the patient admission-to-discharge cycle
- Ensure compliance with healthcare regulations, insurance/corporate
contractual obligations, SHA requirements, and internal administrative
controls
- Collaborate with clinical, billing, and finance teams to close gaps
at the point of patient registration, authorization, and discharge
documentation
Key
Competencies
- Analytical thinking and attention to detail
- Strong communication and negotiation skills
- Leadership and team development
- Process improvement orientation
- Patient-centred service mindset and understanding of healthcare
operations
Requirements
- Diploma or Bachelor’s degree in Health Records & Information
Management, Business Administration (Healthcare), Nursing, or a
related field
- Minimum 3 years’ experience in a hospital front office, admissions,
or medical billing environment.
- Proficiency in a Hospital Management Information System (HMIS);
familiarity with SHA and private insurer authorization platforms
- Working knowledge of Kenya’s Social Health Insurance, private
insurance/corporate framework (SHA) and insurance/corporate panel
processes
- Training in medical billing or insurance/corporate claims processing
is an added advantage
How to Apply
