Credit Control & Receivables Manager

Job Purpose

The Credit Control & Receivables Manager will oversee credit management and receivables operations of AMCE, ensuring efficient management of patient accounts, insurance claims, and payments. The role holder will develop and implement credit policies, manage patient accounts, and ensure timely reimbursement from insurance providers and maintain high levels of patient satisfaction while minimizing bad debt expenses.

Core Responsibilities

Receivable Management

• Establish and maintain credit policies and procedures to minimize credit risk, assess creditworthiness of new and existing customers, set credit limits and monitor credit utilization, implement credit checks and approval processes, and analyze credit information from credit bureaus and other sources.
• Monitor and manage accounts receivable aging, follow up on overdue invoices and resolve billing discrepancies and implement effective collection strategies, including sending reminders, making phone calls, and sending collection letters.
• Prepare regular reports on accounts receivable aging, bad debt expense, and other key metrics, analyze trends, and identify opportunities for improvement and provide insights to management on credit and collection performance.
• Accurately and timely apply customer payments to invoices, resolve discrepancies between payments and invoices and reconcile bank accounts and identify any discrepancies.
• Monitor customer credit risk and take appropriate action to mitigate risk, analyze customer payment behavior to identify trends and potential issues and implement credit risk mitigation strategies, such as requiring upfront payments or collateral.

Insurance Claims and Reimbursement

• Receive and acknowledge insurance claims, verify the accuracy and completeness of claim information, and determine eligibility for coverage based on policy terms and conditions.
• Investigate claims to gather necessary documentation and evidence, assess the validity and extent of claims and determine the appropriate level of reimbursement.
• Process claims accurately and efficiently, verify medical necessity and coding accuracy.
• Calculate reimbursement amounts based on contract terms and fee schedules and issue payments to providers and patients.
• Identify and appeal denied claims, develop, and implement strategies to reduce denial rates and work with insurance payers to resolve claim disputes.
• Implement fraud prevention and detection measures and monitor claims for potential fraud, waste, and abuse.
• Collaborate with compliance and legal teams to investigate and report suspected fraud.
• Stay updated on healthcare regulations and compliance requirements, ensure compliance with relevant regulations, and implement internal controls to mitigate compliance risks.

Patient Account Management

• Manage patient account inquiries and disputes.
• Ensure accurate and timely patient registration and demographic data collection, verify insurance eligibility and benefits and update patient information as needed.
• Explain billing statements and insurance coverage to patients, answer patient questions and concerns about billing and insurance and assist patients with financial arrangements, including payment plans and financial assistance.
• Verify insurance eligibility and benefits for each patient encounter, obtain pre-authorization for services as required by insurance plans and appeal denied claims to maximize reimbursement.
• Communicate effectively with patients, insurance companies, and internal staff, resolve patient billing issues and complaints promptly and provide excellent customer service to ensure patient satisfaction.

Credit Management

• Develop and implement credit policies and procedures for AMCE, ensuring compliance with Nigerian healthcare regulations.
• Evaluate patient creditworthiness and determine credit limits, considering financial history and insurance coverage.
• Monitor and manage patient accounts, identifying potential credit risks and implementing mitigation strategies.
• Collaborate with clinical staff to ensure accurate patient billing and insurance information.
• Conduct regular reviews of credit policies to ensure effectiveness.

Financial Analysis and Reporting

• Prepare accurate and timely financial statements, including income statements, statement of financial position, and cash flow statements, ensure compliance with relevant accounting standards (IFRS) and regulatory requirements and analyze financial data to identify trends, potential issues, and opportunities.
• Analyze financial variances between actual and budgeted performance, identify the root causes of variances and recommend corrective actions. Prepare variance analysis reports for management review.
• Develop and implement annual budgets and long-range financial plans, monitor budget performance, and identify potential risks and opportunities and prepare financial forecasts and projections.
• Analyze and allocate costs to different departments and services to improve cost efficiency and develop and implement cost-control measures.
• Create and maintain financial models to support strategic decision-making and conduct sensitivity analysis to assess the impact of different scenarios on financial performance.