Revenue Assurance Manager

Valley Hospital is a leading Level 4 hospital in Nakuru City offering both inpatient and outpatient services.

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.

1. Develop, implement, and enforce policies that ensure the accuracy and completeness of patient billing information
2. Oversee timely submission of clean claims to insurance providers, corporates, and government schemes (including SHA)
3. Investigate and resolve claim denials, underpayments, and billing errors, implementing corrective action to reduce recurrence
4. Monitor billing error rates and drive continuous improvement towards industry benchmarks
5. Maintain and Manage relationships with insurance companies and corporate clients
6. Negotiate and maintain up-to-date knowledge of payer contracts, fee schedules, and pre-authorisation requirements
7. Liaise with payers to resolve disputes, verify eligibility, and follow up on payer commitments
8. Lead, supervise, and develop the revenue cycle team including billing staff, coders, and collections officers
9. Set performance targets, conduct appraisals, and identify training needs
10. Foster a culture of accuracy, accountability, and patient-centred service
11. Track and report on key performance indicators including denial rates, first-pass resolution rates, clean claim rates, and admission/discharge turnaround times
12. Prepare regular revenue cycle reports for the Finance Director and senior management
13. Identify trends and recommend operational or policy changes to optimize revenue capture
14. Implement policy changes to reduce claim errors and shorten the revenue cycle
15. Ensure compliance with healthcare billing regulations, insurance contractual obligations, and internal financial controls
16. Collaborate with clinical, front-office, and finance teams to close gaps at the point of patient registration and discharge documentation

1. Diploma or BsC in Nursing, Bachelors degree in finance, Accounting, Health Information Management, or a related field
2. 4–6 years of progressive experience in a hospital and/or insurance setting with at least 2 years in a supervisory capacity
3. Strong working knowledge of insurance and care billing processes and relationship management
4. Proficiency in Hospital/Health Management Information Systems (HMIS) and billing software
5. Familiarity with SHA, private insurance and corporate care protocols.
6. Analytical thinking and attention to detail
7. Strong communication and negotiation skills
8. Leadership and team development
9. Process improvement orientation
10. Financial acumen and understanding of healthcare operations