Job Description

Valley Hospital is a leading Level 4 hospital in Nakuru City offering both inpatient and outpatient services. We are seeking to recruit a Revenue Assurance Manager to join our Finance Department.

He/She will play a crucial role in managing and maximizing the hospital’s revenue cycle by ensuring accurate billing, claims processing, collections, and financial reporting. This position requires a blend of financial acumen, client relationship management expertise, and a basic understanding of clinical processes. The manager will oversee a team responsible for revenue accounting, claims, admissions, and receivables, ensuring a seamless flow of financial operations.

Key Responsibilities

Billing & Claims Management

• Develop, implement, and enforce policies that ensure the accuracy and completeness of patient billing information
• Oversee timely submission of clean claims to insurance providers, corporates, and government schemes (including SHA)
• Investigate and resolve claim denials, underpayments, and billing errors, implementing corrective action to reduce recurrence
• Monitor billing error rates and drive continuous improvement towards industry benchmarks

Insurance & Corporate Accounts

• Maintain and Manage relationships with insurance companies and corporate clients
• Negotiate and maintain up-to-date knowledge of payer contracts, fee schedules, and pre-authorisation requirements
• Liaise with payers to resolve disputes, verify eligibility, and follow up on payer commitments

Team Leadership & Department Oversight

• Lead, supervise, and develop the revenue cycle team including billing staff, coders, and collections officers
• Set performance targets, conduct appraisals, and identify training needs
• Foster a culture of accuracy, accountability, and patient-centred service

Metrics, Reporting & Analytics

• Track and report on key performance indicators including denial rates, first-pass resolution rates, clean claim rates, and admission/discharge turnaround times
• Prepare regular revenue cycle reports for the Finance Director and senior management
• Identify trends and recommend operational or policy changes to optimize revenue capture

Process Improvement & Compliance

• Implement policy changes to reduce claim errors and shorten the revenue cycle
• Ensure compliance with healthcare billing regulations, insurance contractual obligations, and internal financial controls
• Collaborate with clinical, front-office, and finance teams to close gaps at the point of patient registration and discharge documentation

Requirements

Qualifications & Experience

• Diploma or BsC in Nursing, Bachelors degree in finance, Accounting, Health Information Management, or a related field
• 4–6 years of progressive experience in a hospital and/or insurance setting with at least 2 years in a supervisory capacity
• Strong working knowledge of insurance and care billing processes and relationship management
• Proficiency in Hospital/Health Management Information Systems (HMIS) and billing software
• Familiarity with SHA, private insurance and corporate care protocols.

Key Competencies

• Analytical thinking and attention to detail
• Strong communication and negotiation skills
• Leadership and team development
• Process improvement orientation
• Financial acumen and understanding of healthcare operations