HMO Coordinator

Job Summary: The HMO Coordinator or Member Relations Representative (MRR)/HMO Officer is responsible for providing effective administrative support to the Hospital Liaison Officers Department and ensuring the proper implementation of plan policies.

Key Responsibilities:

• Assist IHC members during their availment to contribute to employee engagement and retention.
• Ensure members' queries, concerns, and complaints are attended to in a timely and appropriate manner.
• Keep abreast with current regulations and policies affecting medical services and implementation.
• Be up to date on medical updates, utilization management, newly onboarded and renewed account benefits.
• Maintain company spiels and lines that will entice members to call them regarding their benefit.
• Ensure that the member's coverage and benefits is discussed appropriately and issue the letter of authorization (LOA).
• Assist the member during their availment by checking medical facility charges and professional fees to maximize member's benefits.
• Issue LOAs and assist members for MD scheduling of appointments and other services.
• Distribute service evaluation survey forms and ensure that the targeted confidence level and margin of error is met on a monthly basis.
• Participate in current process review and development of new and/or revised work processes, policies, and procedures relating to Utilization Management responsibilities.
• Build and maintain good rapport with IHC's designated Hospital Care Director (HCD) in the hospital, IHC's roster of accredited physicians, and provider personnel.