Medical Administrator – Billing & Clinical Administration

Role Overview

This role sits at the centre of a busy outpatient clinic, making sure every consultation, procedure, test, and medication is accurately captured and converted into revenue. You will own the full billing journey—from verifying a patient’s cover before they see a clinician to reconciling payments at the end of the day—while keeping insurance claims moving and documentation audit-ready. Your work directly protects the facility’s cash flow and keeps patient access smooth, so this is a position where precision and speed genuinely matter.

Key Responsibilities

• Log all patient charges from consultations, procedures, pharmacy dispensing, laboratory investigations, and consumables directly into the electronic health records system.
• Generate invoices, official receipts, and account statements for walk-in and insured patients, ensuring each transaction ties back to the clinical services actually delivered.
• Validate patient eligibility, benefit limits, and required pre-approvals for Social Health Authority (SHA) and private medical insurance before care begins.
• Apply correct coding for diagnoses, procedures, and services so that every claim is submitted compliantly and within insurer deadlines.
• Chase outstanding claim approvals, resolve rejection reasons, correct missing codes, and request additional documentation from clinical teams as needed.
• Reconcile daily billings against service registers, payments received, and banking records, flagging any gaps that could indicate revenue leakage.
• Support clinicians and nurses by confirming that prescriptions, lab orders, and procedure notes match what is ultimately billed, reducing audit findings.
• Coordinate with pharmacy, laboratory, and front-desk staff to keep patient flow efficient and waiting times low while ensuring no chargeable item is missed.

Requirements & Qualifications

• Diploma or degree in Health Records, Business Administration, Finance, or a closely related discipline from a recognised institution.
• At least two to three years of hands-on experience in hospital billing, health records management, or medical insurance administration, preferably in a Kenyan healthcare setting.
• Working familiarity with SHA (including former NHIF procedures), private medical insurer requirements, and standard medical coding frameworks.
• Practical experience using electronic medical records and hospital billing or inventory systems to track charges, claims, and payments.
• Strong numerical accuracy, attention to detail, and a methodical approach to reconciliation and audit trail maintenance.
• Clear communication and interpersonal skills to coordinate effectively with clinical, pharmacy, laboratory, and finance colleagues.
• Demonstrated ability to work under pressure in a high-volume outpatient setting without compromising data integrity or confidentiality.
• Commitment to professional ethics, financial accountability, patient privacy, and data protection regulations.