Medical Referral Services Coordinator

1 day ago

Bonifacio Global Metro Manila, Philippines TakeCare Asia Philippines, Inc. Full time ₱250,000 - ₱350,000 per year

Job Specifications:

Graduate of Bachelor's Degree Graduate in any health related field; license is not required.

Previous formal experience is not required.

Experience with providing warm and pleasant customer service while assisting walk-in members regarding issues and concerns such as but not limited to eligibility, benefit administration, claims, billing reimbursements is preferred.

Effective team player with excellent interpersonal relationship skills and can work and relate well with co-employees, patients and customers.

Must have the behavioral sensitivity, maturity, diplomacy and tact in addressing complex situations and handling irate customers.

Outstanding oral and written communication skills.

Strong ethics and a high level of personal and professional integrity.

Must have basic familiarity on laws and requirements relating to healthcare management.

Computer literate and proficient in using MS office programs.

Duties and Responsibilities:

I. Medical Referral Office Services

Greets and assists walk-in members.

Handles and documents check-in of walk-in members on log-sheet.

Helps/assists walk-in members connect with the right department and/or individuals

Answers incoming calls and directs them accordingly.

Forwards inquiries and concerns to appropriate staff/departments (e.g. other Medical Referral Office staff, Medical Management, Claims, Customer Service, MAS, Sales, etc.) or providers (e.g. doctor's clinics, hospital departments, etc.)

Secures appointments for members related to their off-island referral.

Assist members to providers' clinics for their consultations and to departments within the provider facilities for various medical services and procedures.

Provides offsite letters of authorization to members for services not requiring prior authorization.

Provides assistance and support to members throughout the admission and discharge process for inpatients.

10.    Computes and explains member's financial responsibility by reviewing statements of account.

Provides customer support throughout the care coordination including but not limited to any of the following concerns:

11.1. Authorization (including Off-Island),

11.2.Eligibility,

11.3. Benefit Administration,

11.4.Referrals,

11.5. Appointments,

11.6.Claims,

11.7. Billing,

11.8.Reimbursements,

11.9.Plan Deductible,

Referrals (status & process),

Insurance Coverage,

Coordination of Benefits

Services available,

Network Providers/Access,

Medical Records

Appeals

Grievances

12.    Provides assistance to member for concerns related to off-island travel, transportation, accommodation, etc.

Provides benefit information to members to facilitate understanding of benefit coverage, plan limitations and exclusions.

II. Administrative Support

Collects updated membership information from walk-in members.

Updates and maintain member walk-in, phone, and email inquiry demographics on a weekly basis.

Updates and organizes member files.

Regularly inputs member-related information into the company's digital database.

Provides administrative support related to Medical Referral Office functions.

Performs other duties that may be assign from time to time.

Job Summary:

Reports directly to the Medical Referral Office Lead, responsible for providing warm and pleasant customer service in assisting members regarding issues and concerns such as but not limited to off-island authorization, eligibility, benefit administration, claims, billing, reimbursements, medical records, etc. and administrative support to functions related to the Medical Referral Office processes

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