HMO In-Patient Specialist

5 days ago

Makati City, National Capital Region, Philippines InLife Health Care Full time ₱1,200,000 - ₱2,400,000 per year

JOB DESCRIPTION

  1. Ensure the proper monitoring of confinements of iCare members in accredited medical facilities.

  2. 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.

  3. Keep abreast with current regulations and policies affecting medical services and implementation and provide proper guidance to all concerned.

  4. Be up to date on medical updates, utilization management, newly onboarded and renewed account benefits.

  5. Maintain company spiels and lines that will entice members to approach him/her regarding their benefit including medical network inquiries, concerns and LOA issuances

  6. Visit admitted members ensuring to discuss the member's coverage and benefits and issue the letter of authorization (LOA).

  7. Monitor daily the member's progress chart to know member's needs and current medical condition.

  8. 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.

  9. 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.

  10. Visit hospital administrators, HCDs and iCare- accredited doctors to act promptly on their concerns (i.e., unpaid claims, distribution of checks, implementation of new hospital policies, etc.).

  11. 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.

  12. 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.

  1. Distribute service evaluation survey forms and ensure that the targeted confidence level and margin of error is met on a monthly basis.

  2. Receive comments, suggestions and feedback and collates survey results.

  3. 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.

  1. Work with internal and external leaders in areas affecting department operations.

  2. Contribute to create processes for Medical Audit and ensure proper application through an established and agreed medical audit exercise.

  3. Participate in current process review and development of new and / or revised work processes, policies and procedures relating to Utilization Management responsibilities.

  4. Submit reports relative to duties and responsibilities.

  • HMO Concierge Specialist

    21 hours ago

    Makati City, National Capital Region, Philippines Surevax Full time ₱1,200,000 - ₱2,400,000 per year

    Company Overview:We are an emerging group of companies at the forefront of healthcare, fintech, and innovative solutions, dedicated to improving lives through cutting-edge technology and forward-thinking approaches. As we grow, we are seeking a proactive and highly organized Executive Assistant to support our leadership team in navigating an exciting period...

  • Patient Engagement Specialist

    5 days ago

    Makati City, National Capital Region, Philippines Booth and Partners Pte Ltd Full time ₱1,200,000 - ₱2,400,000 per year

    Job Description OpenLoop is looking for a Patient Engagement Specialist to join our team. This role will be a member ofthe Revenue Cycle Management Team, collaborating closely with the Eligibility and Benefits Head.Job Summary:We are seeking a detail-oriented and knowledgeable Eligibility and Benefits Specialist to attend andoversee the eligibility...

  • Online Patient Care Specialist

    1 week ago

    Makati City, National Capital Region, Philippines One Nadela Medical Group Full time ₱250,000 - ₱350,000 per year

    Online Patient Care SpecialistJob Overview:We are seeking a dedicated Online Patient Care Specialist to handle patient inquiries, manage online bookings, and provide administrative support with initiative and professionalism. The role is vital in ensuring a smooth and efficient clinic experience for our patients while upholding excellent customer service...

  • Patient Experience

    1 week ago

    Mandaluyong City, National Capital Region, Philippines OPAT The Antibiotic Care Specialist Full time ₱600,000 - ₱1,200,000 per year

    This role combines patient advocacy, doctor engagement, and business development support by:Guiding & supporting patients as they undergo their OPAT treatment,Serving as the main liaison between the OPAT clinic and referring doctors for effective patient care collaboration,Offering the clinic's core services to doctors and elastomeric pump solutions to...

  • Patient Care Coordinator

    5 days ago

    Makati City, National Capital Region, Philippines MedGrocer Full time ₱900,000 - ₱1,200,000 per year

    MedGrocer's digitally-enabled wellness and population health programs, telehealth and medical services, and onsite medical staff work with hundreds of pharma companies and employers 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...

  • hmo clerk

    2 weeks ago

    Quezon City, National Capital Region, Philippines Novaliches General Hospital Incorporation Full time ₱204,000 - ₱250,000 per year

    An HMO clerk in a hospital acts as a liaison between patients, the hospital, and health insurance providers. Key duties include verifying patient insurance coverage, processing claims and forms, coordinating appointments and procedures, and helping patients understand their benefits. They also handle administrative tasks like maintaining member files and...

  • HMO Associate

    2 weeks ago

    Quezon City, National Capital Region, Philippines FE DEL MUNDO MEDICAL CENTER Full time ₱400,000 - ₱1,200,000 per year

    DUTIES AND RESPONSIBILITIESFacilitates Out-Patient consultation and diagnostic procedures and treatments.Facilities Out-Patient Approval for OR procedure.Endorses patients to the designated departments.Encoding of OPD patients PF consultation and diagnostic procedure to the Bizbox.Keeps himself/herself updated on knowledge of the policy and coverage.Relieves...

  • HMO Staff

    5 days ago

    Quezon City, National Capital Region, Philippines Diliman Doctors Hospital, Inc. Full time ₱250,000 - ₱500,000 per year

    About the roleWe are seeking a talented and driven HMO Staff to join our team at Diliman Doctors Hospital, Inc. in Quezon City, Metro Manila. As an HMO (Health Maintenance Organization) Staff, you will play a crucial role in managing and coordinating the healthcare services provided to our patients. This is a full-time position with the opportunity to be...

  • Patient Service Representative

    2 weeks ago

    Makati City, National Capital Region, Philippines MedGrocer Full time ₱200,000 - ₱300,000 per year

    MedGrocer'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....

  • Head of Patient Experience

    2 weeks ago

    Makati City, National Capital Region, Philippines Maxicare Health Care Full time ₱1,500,000 - ₱3,000,000 per year

    As 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...