HMO Coordinator

4 days ago

Pulong Santa Cruz, Calabarzon, Philippines Vera. Dental Clinic Full time $40,000 - $55,000 per year

Job description:

I. Job Summary

An HMO Coordinator (Health Maintenance Organization Coordinator) is responsible for managing relationships between patients, healthcare providers, and insurance companies, especially in the context of HMOs. Their goal is to ensure efficient processing of health insurance claims, authorizations, and patient services within the scope of an HMO plan.

II. Primary Duties and Responsibilities:

1. Patient and Insurance Coordination

  • Verify patients' HMO coverage and eligibility prior to appointments or procedures
  • Explain HMO benefits, coverage limitations, and policies to patients
  • Assist patients in securing pre-authorization or referrals for services\
  • Coordinate with receptionist, supervisor and patients to ensure treatment is aligned with insurance requirements

2. Pre-Authorization and Claims Processing

  • Obtain necessary approvals for diagnostics and treatments from HMOs
  • Submit claims and follow up on claim status with HMO providers
  • Resolve issues related to denied or delayed claims
  • Track and ensure proper documentation for all authorized services

3. Records Management

  • Maintain accurate and updated patient records, insurance documents, and authorizations
  • Prepare reports related to HMO utilization, approved and not approve request.
  • File and archive insurance-related paperwork according to company policies

4. Liaison Duties

  • Serve as the primary point of contact between the clinic and HMO providers
  • Communicate with Clinic Staff, administrative staff, and external insurance agents
  • Attend meetings or training related to HMO policies and updates

5. Administrative Support

  • Maintain and update HMO databases or google sheet and tracking systems
  • Assist billing departments in coordinating insurance payments.
  • Monitor compliance with healthcare regulations and HMO contracts
  • Ensure patient record is complete details and information.

QUALIFICATIONS:

  • Bachelor's Degree/College Graduate
  • OPEN to Fresh Graduate
  • Knowledge of HMO and insurance procedures
  • Strong organizational and multitasking skills
  • Excellent communication and customer service
  • Attention to detail in documentation and claims tracking
  • Familiarity with electronic medical records (EMR) and billing systems

Job Types: Permanent, Fresh graduate

Benefits:

  • Additional leave
  • Company events
  • Employee discount
  • Free parking
  • On-site parking
  • Opportunities for promotion
  • Paid training
  • Promotion to permanent employee

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