Job Hiring jobs in Rosales

I. Job Summary:

The PhilHealth Staff is responsible for ensuring accurate and timely processing, monitoring, and submission of all PhilHealth-related claims and requirements. The role ensures compliance with PhilHealth policies, claim guidelines, and hospital accreditation standards, supporting efficient reimbursement and maintaining good standing with PhilHealth.

II. Duties and Responsibilities:
A. Claims Processing

• Prepare and process PhilHealth claims (CF1, CF2, CF3, claim forms, attachments) accurately and on time.
• Verify patient eligibility, admission details, and completeness of documents prior to submission.
• Encode claim information in the PhilHealth electronic system (eClaims, iClaims, or Hospital Information System).
• Coordinate with billing, nurses, and medical records for required supporting documents.
• Monitor returned or denied claims and coordinate for corrections or resubmissions.

B. Coordination and Compliance

• Serve as the focal person for all PhilHealth transactions and communications.
• Ensure compliance with updated PhilHealth circulars, policies, and benefit packages.
• Attend PhilHealth orientations, briefings, and trainings as required.
• Coordinate with PhilHealth Regional Office for accreditation and renewal processes.

C. Documentation and Reporting

• Maintain accurate and organized records of PhilHealth claims, remittances, and reimbursements.
• Prepare periodic reports (daily, weekly, monthly) of claims status and collections.
• Reconcile PhilHealth reimbursements with accounting records.

D. Patient Assistance

• Assist patients in filling out PhilHealth forms and explain requirements and benefits.
• Verify and validate patient eligibility via PhilHealth’s portal or membership database.

III. Qualifications:

• Education: Bachelor’s degree in Business Administration, Accounting, Health Information Management, or any related field.
• Experience: Preferably with at least 1 year of experience in PhilHealth claims processing or hospital billing.
• Knowledge:
• Familiar with PhilHealth rules, benefit packages, and claim procedures.
• Knowledge in eClaims / iClaims system is an advantage.
• Skills:
• Detail-oriented and organized
• Good communication and coordination skills
• Computer literate (MS Office, hospital systems)

Job Type: Full-time

Benefits:

• Company Christmas gift
• Employee discount
• Paid training
• Pay raise
• Promotion to permanent employee

Location:

• Rosales (Preferred)

Work Location: In person