Reimbursement Manager

1 week ago

Makati City, National Capital Region, Philippines AIA Hong Kong Full time

MediCard Phils., Inc. is one of the country's leading HMOs and the only HMO founded and run by doctors. Since its inception, the concept of service-oriented total health care has been MediCard's guiding principle. Despite the competitive landscape and tempting benefits offered by competitors, MediCard has maintained its lead by providing innovative and cost-effective health maintenance solutions without compromising quality.

MediCard now boasts over half a million members and more than 54,000 accredited doctors across 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that offer hospital-level services without confinement.

MediCard is currently looking for assertive, dynamic, and energetic individuals to fill the following vacancy:

Reimbursement Monitoring Specialist
  1. Monitors and checks the performance of reimbursements for accurate and efficient processing of check payments to members/claimants and express payment bills.
  2. Ensures proper evaluation of medical cases.
  3. Monitors the performance of the Reimbursement section and ensures SLAs are being met.
  4. Checks and finalizes all claims with action and disapproval memos.
  5. Assists in addressing doctors' concerns regarding professional fees and participates in the reconciliation process for unpaid and underpaid claims, coordinating with the Reimbursement Medical Administrator.
  6. Attends to claimants' concerns.
  7. Handles online inquiries from external and internal clients.
  8. Reports to the AVP on the concerns of clients and the Reimbursement Section.
  9. Conducts weekly reviews of unpaid and unprocessed bills in the Reimbursement Section.
  10. Develops strategies and action plans to increase and maintain member satisfaction.
  11. Prepares reconsideration forms for all letters of appeal on denied reimbursement cases for discussion with the reconsideration committee for final review and action.
  12. Prepares quarterly ISO reports on Reimbursement, including timely payments, actions, denials, and quota reports.
  13. Performs other tasks related to the main objective.
Qualifications and Guidelines:
  • Graduate of Medicine, Allied Health Professional courses, or any Business course.
  • At least 5 years of work experience and practice of the profession.
  • Excellent interpersonal and organizational skills.
  • Basic computer skills, e.g., Microsoft Office.
  • Process management skills, people, and customer relations skills.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

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