US HMO Coordinator

2 days ago

San Jose del Monte, Central Luzon, Philippines ACS Pro Global Full time ₱300,000 - ₱500,000 per year

HMO Coordinator are responsible for monitoring and managing patients' overall HMO insurance involvement. They coordinate with insurance case managers, billing staff, and skilled nursing facilities to ensure that Authorizations are up to date and necessary documents are timely endorsed.

JOB RESPONSIBILITIES:

  • Ensure every HMO insurance managed patient, in this category, is admitted with the proper authorization and benefits for short term rehabilitation.

  • Real-time tracking of relevant authorizations.

  • Ongoing communication with the insurance case manager, for continued authorizations and matched with each patients' level of care. This includes the submission of comprehensive clinical updates to the insurance provider.

  • HMO Notice of Non-Coverage and other HMO denial coordination.

  • Communication with the billing departments to facilitate claim submission, as well as monthly pre-billing triple checks for all authorized days.

  • Denial management — including tracking, response, and appeal.

  • Participation in the SNF's utilization review meetings.

  • Real-time communication with the SNF's interdisciplinary team.

MINIMUM QUALIFICATIONS:

  • Preferably professionals with healthcare background, or at least obtained medical degree (Therapists, Nurses, Medical Technology)

  • Familiar with medical terminology

  • Good communication skills

EXPERIENCE LEVEL:

  • With billing account experience is also an edge.

  • With experience in insurance verification and authorization.

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