Inpatient Liaison Officer
2 weeks ago
This is for a direct hire and permanent position.
Job Summary
The Liaison Officer will be responsible for generating, reviewing, approving, disapproving, issuing, and updating of Letters of Authorization within approved authority limits. They will also be responsible for keeping track of and updating of the member billing as needed, as well as analyzing and calculating of potential excess charges for members, if applicable, and communicating coverage details to providers accordingly.
Responsibilities
• Screen, evaluate and process LOA availment based on the standard procedures and benefit applications guidelines
• Issues Letter of Authority (LOA) after assessment of coverage, professionally explain coverage and non coverage to the member
• Secure overriding approval from the In-Patient Supervisor for LOAs beyond the Specialist's authority limits include tagging of special approval
• Discuss Medical Availment Guideline (MAG) to member
• Monitor member's confinement based on the defined criteria
• Responds to inquiries and complaints at first hand solution (if possible) on customer's feedback and issues raised
• Assists in resolving issues/concerns escalated to various departments/units and refer to Supervisor unresolved issues beyond the TAT set
• Encodes, processes and submits claims to Quality Control/Supervisor for approval
• Ensure all availments/claims are properly documented, filed and uploaded accordingly
• Complies to pre advised shift schedule and ensure to support Operation 24/7 and or assigned to hospital as when needed
• Reports any system-related issued and Team concerns to expedite processing
• Assist IP handler in securing Certificate of Availment of member.
Qualifications
Graduate of any medical allied 4 or 5-year course, or undergraduates with at least 1 year of BPO experience in healthcare industry that is trainableAt least 6 months hospital experience is preferred, but not requiredCapable of reading and comprehending Statements of AccountAmenable to work on a rotational shift schedule in any of the following sites*Quezon City, Alabang, Ermita, Taguig, or Davao (hybrid setup**)*Relocation may be possible, but not guaranteed**You may work from the office or from the hospital you will be assigned toFull-time position available-
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