HMO Coordinator
4 weeks ago
Seeking a HMO Coordinator to provide administrative support to the Hospital Liaison Officers Department and ensure effective implementation of plan policies resulting in utilization management. The ideal candidate will have good communication, coordination, and negotiation skills, with experience in insurance/HMO and value-adding services preferred.
**Key Responsibilities:**
• Assist IHC members during their availment to contribute to employee engagement and retention
• Ensure that IHC members availing of medical services in accredited medical facilities are assisted accordingly
• Maintain company spiels and lines that will entice members to call them regarding their benefit
• 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
• Increase the roster of accredited medical facilities especially physicians
• Conduct initial claims for reimbursement screening submitted by members and inform members of any lacking documents, if any
• Monitor claims and inform members of acceptance/denial and release of checks
**Requirements:**
• Graduate of any 4-year college course, medical allied (preferred)
• Experience in insurance/HMO and value-adding services preferred
• Good communication, coordination, and negotiation skills
• With BPO experience handling healthcare account is an advantage
• Okay for project-based employment
• Okay for 1:00 PM to 10:00 PM SCHEDULE
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