patient care advocate

1 day ago

Cebu City, Central Visayas, Philippines PhilCare Inc. Full time ₱250,000 - ₱500,000 per year

JOB SUMMARY:

The position is essentially responsible in effectively carrying out set strategies of Customer Experience Divisionrelevant to the confinement of valued members. It ensures customer satisfaction through effective rapportand proper utilization management.

DUTIES AND RESPONSIBILITIES:

1. CUSTOMER EXPERIENCE

  • Always ensures efficient execution of best-in-class Customer Experience the assigned provider
  • Closely monitors admission/s in assigned/ affiliated providers
  • Creates case and Authorization in One System; updates discharge date within 24hours
  • Visits admitted member and reorients benefit plan and requirements during the admissionand ensures understanding through acknowledgement of Visit Form
  • Assesses availment and Issues Letter of Authorization accordingly to billing/ credit andcollection
  • Closely monitors member's confinement progress through patient's medical chart
  • Revisits member whenever necessary.
  • May assist member during the discharge to ensure proper computation and collection ofuncoverable charges
  • Captures provider issues such as unpaid claims, implementation of new hospital policies,threat of suspensions etc.
  • Establishes good working relationship / partnership among affiliated providers

2. UTILIZATION MANAGEMENT

  • Reviews and analyzes cases of admission; checks necessity of the confinement and/orprocedure
  • Reviews and reports member's Length of Stay (LOS) and Cost of confinement
  • Coordinates complex/ catastrophic cases to superior or Medical Resource for propermanagement
  • Approves coverage based on authority limit up to P50,000 otherwise, shall refer to authorizedapprover
  • Reports denied admissions

3. REPORT GENERATION

  • End of day report of admissions and discharge
  • Updates the "endorsement to claims" in OS for Claim's reference

QUALIFICATIONS:

  • Graduate of any Medical allied course preferably Nursing/ Physical Therapy
  • Preferably with experience in HMO industry
  • Must be willing to do field work to the assigned clinics/hospitals around Cebu area

Job Types: Full-time, Fixed term

Ability to commute/relocate:

  • Cebu City: Reliably commute or planning to relocate before starting work (Preferred)

Application Question(s):

  • What's your expected salary?
  • Are you willing to do field work?

Education:

  • Bachelor's (Preferred)

Language:

  • Tagalog (Preferred)

Work Location: In person

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