Philhealth Staff

4 days ago

Quezon City, National Capital Region, Philippines Novaliches General Hospital Incorporation Full time ₱300,000 - ₱600,000 per year

The Quality Assurance (QA) Officer of the PhilHealth Department ensures that all claims, documents, and transactions submitted to PhilHealth are accurate, complete, compliant with government guidelines, and aligned with hospital policies. The officer upholds the integrity of PhilHealth operations by monitoring processes, identifying gaps, and implementing corrective actions to minimize claim denials, delays, and financial risks.

Key Duties and Responsibilities

  • Claims Review & Validation
  • Examine and validate all PhilHealth claims for accuracy, completeness, and compliance with PhilHealth policies and circulars.
  • Ensure timely submission of claims to avoid penalties and rejections.
  • Verify supporting documents such as medical abstracts, operative records, and doctors' orders.
  • Quality Monitoring & Compliance
  • Conduct regular audits of PhilHealth claims and patient records.
  • Monitor adherence to hospital and PhilHealth standards to prevent fraudulent, erroneous, or incomplete claims.
  • Ensure compliance with updated PhilHealth circulars, guidelines, and accreditation requirements.
  • Process Improvement
  • Identify recurring issues in claims processing and recommend corrective and preventive actions.
  • Develop and implement quality improvement strategies to enhance efficiency in PhilHealth operations.
  • Work closely with Billing, Medical Records, and Nursing Service Offices to streamline workflows.
  • Reporting & Documentation
  • Prepare periodic reports on claim performance, including rejection rates, reasons for denials, and turnaround times.
  • Document audit findings and recommend solutions to management.
  • Maintain organized records for internal and external audits.
  • Training & Coordination
  • Provide orientation and training to staff regarding PhilHealth policies and updates.
  • Act as liaison between hospital departments and PhilHealth representatives.
  • Support internal and external audits by providing necessary data and explanations.
  • Risk Management
  • Detect potential risks of claim disallowance or fraud and initiate preventive measures.
  • Ensure confidentiality and integrity of patient records and claim documents.

Qualifications

  • Bachelor's degree in Nursing, Accounting, Health Administration, or related field.
  • At least 2–3 years of experience in hospital billing, PhilHealth claims, or quality assurance.
  • Strong knowledge of PhilHealth rules, circulars, and accreditation requirements.
  • Proficient in MS Office and hospital information systems.
  • Excellent attention to detail, analytical, and problem-solving skills.
  • Good communication and interpersonal skills.

Competencies

  • Accuracy and integrity in handling records
  • Knowledge of healthcare policies and PhilHealth standards
  • Process analysis and auditing skills
  • Coordination and teamwork
  • Adaptability to frequent policy changes

Job Types: Full-time, Permanent, Fresh graduate

Pay: From Php15,000.00 per month

Benefits:

  • Discounted lunch
  • Employee discount
  • Free parking
  • On-site parking
  • Paid training
  • Promotion to permanent employee

Work Location: In person

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