HMO Coordinator
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Primary Duties and Responsibilities:
1. Patient and Insurance Coordination
- Verify complex HMO coverage and eligibility for major procedures.
- Explain HMO policies and limitations to patients.
- Coordinate with receptionist, supervisor and patients to ensure treatment is aligned with insurance requirements
2. Pre-Authorization and Claims Processing
- Secure approvals for diagnostics, special treatments, and high-value procedures.
- Supervise claims submissions, track progress, and handle escalations on denied or delayed claims.
- Ensure proper documentation is submitted to HMOs.
3. Records Management
- Validate accuracy of HMO-related patient records maintained by the assistant.
- Prepare consolidated utilization and performance reports (weekly, monthly, quarterly, annual).
- Audit records and claims for completeness and compliance.
4. Liaison Duties
- Act as the official point of contact with HMO representatives.
- Attend HMO-related meetings and training.
- Monitor compliance with healthcare regulations and contracts.
5. Administrative Support
- Delegate clerical and documentation tasks to the HMO Assistant.
- Provide guidance and training to ensure accurate claims processing.
- Recommend process improvements to management.
Willing to work at VERA. Dental Clinic Corporation Head Office located at SAN JOSE BUILDING, TAGAYTAY ROAD, SANTA ROSA, LAGUNA (near AUB and Chowking)
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