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HMO Staff
Permanent, Full-time

Job details

Pay information not provided
Permanent, Full-time
Batangas City

Full job description

1. Patient Assistance & Verification

  • Verify patient identity, membership validity, and coverage eligibility with respective HMO providers.
  • Explain coverage benefits, limits, deductibles, and exclusions clearly to patients and their families.
  • Assist patients with completing required intake forms and submitting medical clearance documentation.

2. LOA & Authorization Processing

  • Process and request Letters of Authorization (LOA) from HMO partners for outpatient consultations, laboratory tests, diagnostic imaging, or inpatient admissions.
  • Coordinate pre-authorization requirements for emergency room admissions, specialized surgeries, or expensive diagnostic procedures.

3. Billing, Claims & Documentation

  • Ensure medical charts, clinical summary forms, physician signatures, and itemized billing statements meet HMO claim guidelines.
  • Prepare and organize billing claims for submittal to HMO accounting/claims departments for timely hospital reimbursement.
  • Manage credit and collection processes related to HMO guarantee letters and co-payments.

4. Hospital & HMO Coordination

  • Maintain communication with HMO liaison officers, accounts managers, and accredited hospital physicians.
  • Track daily patient census and prepare monthly HMO utilization and coverage reports for hospital management.
  • Keep hospital staff updated on current HMO policy changes, accredited doctor rosters, and approval protocols.

Benefits:

  • Additional leave
  • Company Christmas gift
  • Company events
  • Employee discount
  • Free parking
  • On-site parking
  • Opportunities for promotion
  • Paid training
  • Promotion to permanent employee

Work Location: In person

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