Reimbursement Manager

1 week ago

PHMPIMakati City TWC, Philippines AIA Group Full time ₱1,000,000 - ₱1,200,000 per year

MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard.  The competition is vast, and the benefits being offered by the competitors are tempting.  However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.

MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement.

MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy:

Monitors and checks the performance of the reimbursements for accurate and efficient processing of check payments to members/claimants and express payment bills. To ensures that medical cases are evaluated properly.Monitors the performance of Reimbursement section and ensures SLAs are being met.
Checks and finalizes all claims with action and disapproval memo.
Assist in dealing with doctors concern regarding professional fees and as part of the reconciliation process for unpaid and underpaid and coordinates with Reinbursement Medical Administrator
Attends to the concerns of claimants.
Attends to online inquiries of external and internal clients.
Reports to the AVP the concerns of clients and  Reimbursement Section
Weekly review of unpaid and unprocessed bills of Reimbursement Section.
Formulates strategies and action plans on how to increase and maintain member satisfaction.
Accomplishes reconsideration form of all letter of appeal on denied reimbursement cases for discussion to the reconsideration committee for final review and action.
Prepares quarterly ISO reports of  Reimbursement namely timely payment, action and denied reports  and quota reports
Performs other tasks corollary to main objective.

QUALIFICATIONS AND GUIDELINES:
Graduate of Medicine/Allied Health Professional courses/ Any Business course
At least  5 years  work experience and practice of profession.
Excellent interpersonal and organizational skills
Basic computer skills  e.g. Microsoft Office
With Process management skills, people and customer relations skills

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

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