Medical Officer

3 days ago

Makati City, National Capital Region, Philippines Advanced Medical Access Philippines (AMAPHIL) Inc. Full time ₱30,000 - ₱60,000 per year

PRIMARY FUNCTIONS:

  • Provides AMAPHIL members with a holistically positive and pleasant medical availment experience in the accredited providers.
  • Addresses members' concerns regarding their AMAPHIL coverage benefits
  • Monitors daily patient's progress chart to know patient's needs
  • Issues benefit reference, LOAs to the accredited providers every time there is availment based on the turn-around time.
  • Provides feedback to Business Development department regarding customer satisfaction and customer complaints.
  • Executes pre-identified processes and related tasks to delivery expected output

REGULAR TASKS:

  • Responsible for the enrollment of corporate account and members in the system including the set-up of benefits.
  • Serves as the point of contact for members, providers, corporate accounts for availment assistance and other availment related concerns.
  • Process admissions and ensure that verification of coverability (COV) is conducted within 24 hours.
  • Process and provides approval on the request for Letter of Authorization (LOA) for outpatient consult, laboratory, emergency, OPD-OR and clinic setting as long it is within the member's benefit limit and not part of the exclusions.
  • Performs claims adjudication for inpatient within 30 minutes once the member is for discharge and complete medical documents are provided.
  • Coordinates with the corporate account requiring pre-approval prior the issuance of LOA.
  • Screen and process medical reimbursement per member/corporate account endorsement.
  • Process receive medical claims from the providers based on the approved LOA during availment to facilitate the payment.
  • Process doctor's enrollment and updating of CPT rates in the system.
  • Liaise and process APE request of the corporate accounts
  • Attend to customer service request from mobile app and chats from AMAPHIL Facebook account and website.
  • Prepares and submits weekly transaction reports.
  • Carry out ad hoc assignment

QUALIFICATIONS:

  • Graduate of nursing or any medical allied/related course
  • With at least 2 years of relevant experience in medical claims processing.
  • With good communication skills both written and verbal
  • Knowledgeable on MS office applications e.g. excel, word and ppt

Job Types: Full-time, Permanent, Fresh graduate

Benefits:

  • Health insurance
  • On-site parking
  • Opportunities for promotion
  • Paid training
  • Promotion to permanent employee

Ability to commute/relocate:

  • Makati: Reliably commute or planning to relocate before starting work (Required)

Education:

  • Bachelor's (Required)

Work Location: In person

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