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.

Please refer to job description.