PhilHealth Supervisor

PRINCIPAL DUTIES & RESPONSIBILITIES

1. Supervise and manage the PhilHealth claims process, ensuring timely and accurate submission.

2. Review and validate ICD-10 coding and procedures to comply with PhilHealth standards.

3. Ensure completeness and accuracy of all claim's documents and requirements.

4. Handle denied claims and appeals, including proper justification and resubmission.

5. Train and guide staff on PhilHealth policies, procedures, and updates.

6. Coordinate with PhilHealth representatives regarding claims, disputes, and compliance matters.

7. Maintain accurate records and generate reports on claim status, approvals, and rejections.

8. Ensure compliance with the PhilHealth Bench book, Circulars, and other regulations.

9. Work closely with billing, medical records, and finance teams to streamline processes.

QUALIFICATIONS

· Degree holder in Business Administration

Must have a valid ICD-10 certification.

· Must have experience in preparing and submitting PhilHealth claims

· At least 2-3 years of experience in a similar role within a hospital or healthcare setting.

· Strong knowledge of PhilHealth policies, claims procedures, and case rates.

· Familiarity with hospital billing and electronic claims processing systems.

· Excellent attention to detail, organizational, and leadership skills.

Ability to handle multiple tasks and work under deadlines.

Job Type: Full-time

Work Location: In person