philhealth & hmo coordinator

3 days ago

Taguig, National Capital Region, Philippines Shinagawa Lasik & Aesthetics Center Corp. Full time ₱800,000 - ₱1,200,000 per year

JOB REQUIREMENTS:

  • Bachelor's degree in Nursing, Business Administration, Healthcare Management, or a related field.

  • At least 3 years of relevant work experience in healthcare, billing, HMO coordination, and PhilHealth claims processing is required.

  • Familiarity with PhilHealth and HMO processes, documentation, and government compliance is required.

  • Knowledge of ICD-10, RVS codes, and the PhilHealth case rate system is an advantage.

  • Strong organizational, communication, and interpersonal skills.

  • Ability to handle confidential information with integrity.

JOB RESPONSIBILITIES:

  • Process PhilHealth benefit claims for patients in strict compliance with government rules and regulations.

  • Ensure timely filing of PhilHealth forms and all required supporting documents to avoid delays or rejections.

  • Coordinate with billing and accounting departments regarding PhilHealth deductions, payments, and reimbursements.

  • Provide assistance to patients regarding PhilHealth membership and benefit availment procedures.

  • Stay updated on PhilHealth policies, guidelines, and circulars issued by the Philippine Health Insurance Corporation (PHIC).

  • Maintain accurate, organized, and confidential records of all PhilHealth-related transactions and documents.

  • Handle the pre-approval, endorsement, and processing of HMO claims and reimbursement documentation.

  • Verify HMO eligibility and coverage of patients prior to consultations, diagnostic procedures, etc.

  • Monitor HMO utilization and billing, including statement of accounts, provider payments, and claim status.

  • Resolve HMO-related concerns by responding to inquiries, addressing complaints, and coordinating with providers for issue resolution.

  • Perform other related tasks as may be assigned by management from time to time.

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