Philhealth Officer

St. Patrick Supreme Dialysis Center

San Juan

PHP 24,000 - PHP 28,000 a month

Job details

Pay

PHP 24,000 - PHP 28,000 a month

Job type

Permanent
Full-time

Location

San Juan

Full job description

Position Title: PhilHealth Officer

Department: Billing and Claims -Operations

Reports To: Clinic Manager / Operations Manager / Finance

Job Summary:

St. Patrick Supreme Health, Inc (St. Patrick Supreme Dialysis Center) is looking for a PhilHealth Officer responsible for the accurate processing, monitoring, and submission of PhilHealth claims and other related healthcare benefit transactions of the dialysis center.

The role ensures compliance with PhilHealth policies, timely reimbursement of claims, proper documentation, and coordination with patients, staff, and government agencies to minimize claim denials and maximize collections.

Key Duties and Responsibilities:

PhilHealth Claims Processing

Process and submit PhilHealth eClaims accurately and on time.
Verify patient eligibility, MDR, membership status, and benefit availability.
Ensure completeness and correctness of required documents before submission.
Monitor status of submitted claims and reimbursement.

Compliance and Documentation

Maintain updated knowledge of PhilHealth circulars, advisories, and dialysis package guidelines.
Ensure compliance with PhilHealth accreditation requirements.
Maintain organized patient and claims records.
Coordinate preparation of documents during PhilHealth audits or inspections.

Billing and Coordination

Coordinate with nurses, physicians, and billing personnel regarding incomplete or inaccurate documents.
Assist patients regarding PhilHealth requirements and concerns.
Monitor denied, returned, or pending claims and facilitate resolution.

Reporting

Prepare weekly and monthly PhilHealth claims reports.
Monitor collection efficiency and reimbursement trends.
Submit operational updates to management.

Administrative Support

Assist in accreditation renewal and document preparation.
Support process improvement initiatives related to claims processing and reimbursement efficiency.

Qualifications:

Bachelor’s degree in Business Administration, Healthcare Administration, Medical Technology, Nursing, or related field
Knowledge or training in ICD-10 coding (International Classification of Diseases) is preferred to support accurate PhilHealth claims processing and compliance.
Experience in medical coding, diagnosis coding, or chart abstraction is an advantage
Familiarity with linking diagnosis codes to PhilHealth claims submissions is highly desirable
Exposure to hospital or dialysis billing systems using ICD codes is a plus
Experience in PhilHealth processing, healthcare billing, or dialysis center operations preferred
Knowledgeable in PhilHealth eClaims system
Familiar with dialysis benefit packages and healthcare documentation
Strong attention to detail and organizational skills
Good communication , coordination skills and work ethics
Proficient in Microsoft Office and electronic medical records systems