HMO In-Patient Specialist
3 weeks ago
Job Description Ensure the proper monitoring of confinements of iCare members in accredited medical facilities. Ensure that members’ queries, concerns and/or complaints are attended to in a timely and appropriate manner prior to elevating this to the HLO Head. Keep abreast with current regulations and policies affecting medical services and implementation and provide proper guidance to all concerned. 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 approach him/her regarding their benefit including medical network inquiries, concerns and LOA issuances. Visit admitted members ensuring to discuss the member’s coverage and benefits and issue the letter of authorization (LOA). Monitor daily the member’s progress chart to know member’s needs and current medical condition. Assist the member during discharge by checking hospital charges and professional fees to maximize member’s benefits and to prevent incurrence of excess charges beyond the benefit coverage and advise member on non-covered charges. Build and maintain good rapport with iCare’s designated Hospital Care Director (HCD) in the hospital, iCare’s roster of accredited physicians and provider personnel. Visit hospital administrators, HCDs and iCare‑accredited doctors to act promptly on their concerns (e.g., unpaid claims, distribution of checks, implementation of new hospital policies, etc.). Assist in creating and organizing processes, information acquisition and appropriate agreements to ensure alignment with the company's policies on Health & Safety, Quality Assurance, Marketing & Brand Management, and Risk & Integrity Management. Ensure proper gatekeeping and utilization management through: a. Determination of validity of the member status, benefit coverage and maximum available limit prior issuance of LOAs through information garnered from the Medical Account System (MAS). b. Review of cases and checking necessity for confinement and need for medical procedure. c. Coordination of catastrophic cases to superior for case management. Distribute service evaluation survey forms and ensure that the targeted confidence level and margin of error is met on a monthly basis. Receive comments, suggestions and feedback and collates survey results. Assist the Provider Management Division by: a. Increasing the roster of accredited medical facilities especially physicians. b. Do on the spot or provisional accreditation of member accessed/requested physicians and/or medical facilities. c. Updating the records of physicians as the need arises. d. Collecting and/or releasing documents to and from accredited medical facilities. e. Coordinating with accredited medical facilities for payment, OR follow-ups or lifting of suspensions. Work with internal and external leaders in areas affecting department operations. Contribute to create processes for Medical Audit and ensure proper application through an established and agreed medical audit exercise. Participate in current process review and development of new and / or revised work processes, policies and procedures relating to Utilization Management responsibilities. Submit reports relative to duties and responsibilities. #J-18808-Ljbffr
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Patient Care Specialist
4 weeks ago
Makati, Philippines Belo Medical Group, Inc. Full timeJoin to apply for the Patient Care Specialist role at Belo Medical Group, Inc. The Patient Care Specialist primarily attends to patients and customers in the clinic and performs a variety of tasks to ensure services are provided in an effective and efficient manner. Responsibilities Handling Patient or Customer Inquiries or Concerns Greet all patients and...
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Makati, Philippines Emapta Full timeCare Beyond the Clock. Compassion Within Every Call. Bring balance, purpose, and patient focus into your healthcare career. Deliver patient-centered support that extends far beyond the desk—helping every call, record, and appointment flow with care, accuracy, and empathy. Enjoy a fulfilling healthcare career that lets you make a difference while keeping...
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Patient Service Representative | Makati
3 weeks ago
Makati, Philippines MedGrocer Full timeMedGrocer's digitally-enabled medicine programs, telehealth services, and corporate clinic medical staff work with hundreds of employers and pharma companies to improve the physical and mental health of over one million Filipinos every year. Here at MedGrocer, you will contribute to innovative healthcare solutions that enhance accessibility and efficiency....
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Patient Care Representative | Makati
3 weeks ago
Makati, Philippines MedGrocer Full timeMedGrocer's digitally-enabled medicine programs, telehealth services, and corporate clinic medical staff work with hundreds of employers and pharma companies to improve the physical and mental health of over one million Filipinos every year. Here at MedGrocer, you will contribute to innovative healthcare solutions that enhance accessibility and efficiency....
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Patient Care Administrator
2 weeks ago
Makati City, National Capital Region, Philippines Emapta Full time ₱250,000 - ₱500,000 per yearCare Beyond the Clock. Compassion Within Every Call. Bring balance, purpose, and patient focus into your healthcare career. Deliver patient-centered support that extends far beyond the desk-helping every call, record, and appointment flow with care, accuracy, and empathy. Enjoy a fulfilling healthcare career that lets you make a difference while keeping...
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Senior Manager for Patient Experience
2 weeks ago
Makati City, National Capital Region, Philippines Maxicare Health Services, Inc. Full time ₱2,000,000 - ₱2,500,000 per yearAs a senior leader within the Patient Care Division, the Head of Patient Experience is responsible for designing, implementing, and continuously improving Maxicare's patient-experience framework. The role ensures that every interaction reflects empathy, efficiency, and the company's culture of care. This leader translates service standards into actionable...
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Entry Level: Healthcare CSR
2 weeks ago
Makati City, National Capital Region, Philippines Metacom Careers Full time ₱20,000 per yearThis position is located in Metro Manila, specifically in Makati at Alphaland, and is a fixed-term healthcare role with a shifting schedule that requires on-site work. It is open to freshers who are at least 18 years old and have completed either the old high school curriculum or ALS. Applicants should have good communication skills and must be willing to...
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HMO Benefits Onboarding
2 weeks ago
Makati City, National Capital Region, Philippines InLife Health Care Full time ₱600,000 - ₱1,200,000 per yearJob Summary:The Onboarding Specialist is responsible for ensuring a smooth and structured transition for new clients, employees, or partners. This role involves coordinating onboarding activities, ensuring compliance with company policies, and providing support throughout the initial integration period.Key Responsibilities:Manage the end-to-end onboarding...
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Experienced Medical Billing Specialist
4 weeks ago
Makati, Philippines NW Pacifica Medical Billing LLC Full timeExperienced Medical Billing Specialist Responsibilities: Examining eligibility and verifying benefits for treatments, hospitalization, and procedures. Examining patient bills for correctness and completeness, as well as gathering any missing data. In charge of collecting payments from insurance and patients for medical procedures and services. Utilizing...
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Staff Nurse
3 weeks ago
Makati, Philippines TopHealth Medical Clinics Full timeRegistered Nurse (Makati)(Fresh Grads are Welcome) Position: Registered Nurse with a focus on hospital and clinical settings. The role requires exceptional attention to detail, strong communication, flexibility, calmness under pressure, and excellent interpersonal skills. Qualifications Registered Nurse (RN) Experience working in a hospital/ clinical setup...
