United Doctors Medical Center jobs in Quezon City

Job Summary

The PhilHealth Manager is responsible for overseeing the administration and management of PhilHealth-related operations within the hospital. This includes ensuring the accurate processing of PhilHealth claims, managing patient enrollment, monitoring reimbursement processes, ensuring compliance with PhilHealth policies, and facilitating smooth communication between hospital departments and PhilHealth. The role requires strong knowledge of PhilHealth Policies, excellent managerial skills, and the ability to ensure optimal service delivery while maintaining compliance with regulations.

Key Responsibilities

• PhilHealth Claims and Reimbursement Management

- Claims Processing: Oversee the preparation, submission, and tracking of PhilHealth claims to ensure timely and accurate reimbursement for services rendered to patients.

- Claims Review: Ensure that all claims submitted are compliant with PhilHealth policies and regulations, minimizing denials and rejections.

- Dispute Resolution: Handle the resolution of any issues, disputes, or rejections regarding PhilHealth claims and coordinate with the PhilHealth office for claim appeals when necessary.

- Payment Tracking: Monitor PhilHealth reimbursements to ensure they are received promptly and reconcile payments with hospital financial records.

• Patient Enrollment and Benefits Management

- PhilHealth Member Enrollment: Ensure that all eligible patients are enrolled with PhilHealth and that their coverage is properly processed before receiving services.

- Eligibility Verification: Regularly verify patient eligibility and ensure that coverage details are updated.

- Maternity and Special Benefits: Monitor and ensure that maternity care, outpatient, and other PhilHealth benefits are appropriately utilized and processed.

• Compliance and Documentation

- Regulatory Compliance: Ensure compliance with PhilHealth Regulations, Policies, and accreditation standards, including maintaining necessary documentation.

- Audit Preparation: Prepare and facilitate audits from PhilHealth and other regulatory bodies, ensuring that records are complete and accurate for review.

- Report Generation: Prepare regular reports for hospital management on PhilHealth claims, reimbursements, and patient enrollment.

• Coordination and Liaison

- Internal Coordination: Work closely with other departments such as Finance, Patient Services, and Medical Records to streamline PhilHealth processes and ensure efficient service delivery.

- PhilHealth Liaison: Serve as the main point of contact between the hospital and PhilHealth, ensuring clear communication and resolution of any concerns or issues related to claims and reimbursements.

- Staff Training: Conduct training for hospital staff PhilHealth policies, procedures and new initiatives to ensure they are up-to-date on all relevant processes.

• Data Management and Reporting

- Data Monitoring: Collect and analyze data related to PhilHealth claims, reimbursement, patient demographics, and service utilization to identify trends and improve operational efficiency.

- Monthly/Quarterly Reporting: Prepare and submit reports on PhilHealth utilization, reimbursements, claims processing, and other metrics to hospital management.

• Fraud Prevention and Risk Management

- Fraud Prevention: Implement and enforce internal controls to detect and prevent fraudulent claims or misuse of PhilHealth benefits.

- Risk Management: Regularly assess the risk of non-compliance or fraud in PhilHealth processes and take necessary corrective actions.

Qualifications

· Education

- Bachelor’s degree in Healthcare Administration, Business Administration, Nursing, or a related field

· Experience

- At least 3-5 years of experience in healthcare administration or hospital management, with a focus on PhilHealth operations.

- Experience in claims processing, hospital finance, or patient services is highly desirable.

Pay: Php40,000.00 - Php45,000.00 per month

Benefits:

• Employee discount
• Health insurance
• Life insurance
• On-site parking
• Promotion to permanent employee

Work Location: In person