HMO and BILLING COORDINATOR

Key Responsibilities

1. High-Volume Billing & Claims Submission

• Review daily patient charts to ensure accurate documentation of primary care visits, vaccinations, and routine screenings.
• Translate clinical documentation into standardized codes and electronically submit medical claims to various HMO networks.
• Audit entries to ensure strict adherence to negotiated capitation rates or fee-for-service tariffs specific to primary care contracts.
• Minimize turnaround time for claim submissions to maintain a healthy, predictable clinic cash flow.

2. Account Reconciliation & Denial Management

• Assist A/R personnel in reconcilng electronic remittances and payments received from HMO partners against outstanding clinic invoices.
• Track aging accounts receivable and proactively follow up on unpaid claims past the standard 30-day window.
• Analyze, correct, and resubmit denied or rejected claims, gathering necessary clinical notes from primary care doctors to win appeals.
• Collect and log patient co-pays or balances at the time of service or through post-visit invoicing.

3. Compliance & Clinic Administration

• Securely manage patient data and billing files in strict compliance with healthcare privacy regulations (e.g., HIPAA / Data Privacy Act).
• Compile monthly summaries on HMO utilization rates, total billings, and collections success for the management team.

4. Adhoc: Primary Care HMO Utilization & Coordination (from time to time)

• Verify patient enrollment, HMO eligibility, and primary care physician (PCP) assignments before or during patient check-in.
• Coordinate and secure Letters of Authorization (LOAs) or referrals for in-clinic diagnostic tests (e.g., X-rays, routine labs, ultrasounds).
• Serve as the primary liaison between patients, family physicians, and HMO network providers to streamline preventative care plans.
• Guide patients through their HMO benefits, clearly explaining out-of-pocket costs, fixed co-pays, and excluded services.

WORK LOCATION: Protacio Health, Parañaque City

Pay: Php21,000.00 - Php25,000.00 per month

Benefits:

• Additional leave
• Company Christmas gift
• Company events
• Employee discount
• Free parking
• On-site parking

Ability to commute/relocate:

• Parañaque: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• This is a 6-day workweek schedule, will you agree?

Experience:

• HMO Billing & Coordinator: 3 years (Required)

Willingness to travel:

• 50% (Required)

Work Location: In person