PhilHealth Staff

2 weeks ago

Rosales P, Philippines Del Carmen Medical Clinic And Hospital Full time ₱900,000 - ₱1,200,000 per year

I. Job Summary:

The PhilHealth Staff is responsible for ensuring accurate and timely processing, monitoring, and submission of all PhilHealth-related claims and requirements. The role ensures compliance with PhilHealth policies, claim guidelines, and hospital accreditation standards, supporting efficient reimbursement and maintaining good standing with PhilHealth.

II. Duties and Responsibilities:

A. Claims Processing

  • Prepare and process PhilHealth claims (CF1, CF2, CF3, claim forms, attachments) accurately and on time.
  • Verify patient eligibility, admission details, and completeness of documents prior to submission.
  • Encode claim information in the PhilHealth electronic system (eClaims, iClaims, or Hospital Information System).
  • Coordinate with billing, nurses, and medical records for required supporting documents.
  • Monitor returned or denied claims and coordinate for corrections or resubmissions.

B. Coordination and Compliance

  • Serve as the focal person for all PhilHealth transactions and communications.
  • Ensure compliance with updated PhilHealth circulars, policies, and benefit packages.
  • Attend PhilHealth orientations, briefings, and trainings as required.
  • Coordinate with PhilHealth Regional Office for accreditation and renewal processes.

C. Documentation and Reporting

  • Maintain accurate and organized records of PhilHealth claims, remittances, and reimbursements.
  • Prepare periodic reports (daily, weekly, monthly) of claims status and collections.
  • Reconcile PhilHealth reimbursements with accounting records.

D. Patient Assistance

  • Assist patients in filling out PhilHealth forms and explain requirements and benefits.
  • Verify and validate patient eligibility via PhilHealth's portal or membership database.

III. Qualifications:

  • Education: Bachelor's degree in Business Administration, Accounting, Health Information Management, or any related field.
  • Experience: Preferably with at least 1 year of experience in PhilHealth claims processing or hospital billing.
  • Knowledge:
  • Familiar with PhilHealth rules, benefit packages, and claim procedures.
  • Knowledge in eClaims / iClaims system is an advantage.
  • Skills:
  • Detail-oriented and organized
  • Good communication and coordination skills
  • Computer literate (MS Office, hospital systems)

Job Type: Full-time

Benefits:

  • Company Christmas gift
  • Employee discount
  • Paid training
  • Pay raise
  • Promotion to permanent employee

Location:

  • Rosales 2441 P01 (Preferred)

Work Location: In person

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