Medical Officer

4 weeks ago

Marikina, Philippines Amaphil (Advanced Medical Access Philippines Inc.) Full time

PRIMARY FUNCTIONS:
1. Provides AMAPHIL members with a holistically positive and pleasant medical availment experience in the accredited providers.
2. Addresses members’ concerns regarding their AMAPHIL coverage benefits.
3. Monitors daily patient's progress chart to know patient’s needs.
4. Issues benefit reference, LOAs to the accredited providers every time there is availment based on the turn-around time.
5. Provides feedback to Business Development department regarding customer satisfaction and customer complaints.
6. Executes pre-identified processes and related tasks to delivery expected output

REGULAR TASKS:
1. Responsible for the enrollment of corporate account and members in the system including the set-up of benefits.
2. Serves as the point of contact for members, providers, corporate accounts for availment assistance and other availment related concerns.
3. Process admissions and ensure that verification of coverability (COV) is conducted within 24 hours.
4. Process and provides approval on the request for Letter of Authorization (LOA) for outpatient consult, laboratory, emergency, OPD-OR and clinic setting as long it is within the member's benefit limit and not part of the exclusions.
5. Performs claims adjudication for inpatient within 30 minutes once the member is for discharge and complete medical documents are provided.
6. Coordinates with the corporate account requiring pre-approval prior the issuance of LOA.
7. Screen and process medical reimbursement per member/corporate account endorsement.
8. Process receive medical claims from the providers based on the approved LOA during availment to facilitate the payment.
9. Process doctor’s enrollment and updating of CPT rates in the system.
10. Liaise and process APE request of the corporate accounts
11. Attend to customer service request from mobile app and chats from AMAPHIL Facebook account and website.
12. Prepares and submits weekly transaction reports.
13. Carry out ad hoc assignment.

QUALIFICATIONS:
1. Graduate of nursing or any medical allied/related course.
2. With at least 2 years of relevant experience in medical claims processing.
3. With good communication skills both written and verbal.
4. Knowledgeable on MS office applications e.g. excel, word and ppt.

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