HMO Staff - Reliever

JOB OBJECTIVES:

Responsible for processing and coordinating HMO and Company related transactions, ensuring smooth patient admission and discharges, verifying patient coverage, and facilitate approvals and claims. This role plays a vital part in ensuring compliance with HMO and Company policies while delivering excellent customer service to patients.

ESSENTIAL FUNCTIONS:

• Patient Assistance & Coordination

· Verify patient eligibility and benefits coverage under HMO and Company plans.

· Guide patients on HMO & Company policies, coverage, and approval procedures.

· Assist patient in competing necessary HMO and Company documents.

· Coordinate with medical and other department staff regarding HMO & Company coverage limitations and requirements.

• HMO and Company Approvals & Documentation

· Secure approvals and authorizations (LOA) for procedures, treatments, and hospital admissions/services.

· Process approval for requests and follow up with HMO and Company providers.

· Maintain accurate records of approvals, denials, and required documentation.

· Ensure compliance with HMO agreements and hospital policies.

• Billing & Claims Processing

· Prepare and process HMO and Company claims for hospital services.

· Ensure accurate encoding of patient details, services rendered, and charges.

· Follow up on unpaid claims, rejections, and appeals with HMO providers.

· Coordinate with HMO and Company regarding billing and collections.

• Communication and Coordination

· Attend meetings and training sessions related to HMO policies and updates.

· Address patient and HMO-related concerns promptly and professionally.

· Keep the hospital updated on changes in HMO guidelines and policies.

• Other tasks that may be assigned by the superior and/or top management from time to time.

QUALIFICATIONS:

a. Graduate of Bachelor’s degree in Accounting, Finance, or a related field.

b. At least 1–2 years of experience in accounts payable or disbursement processing, preferably in a healthcare or hospital setting.

c. Familiarity with accounting software (e.g., Bizbox), MS Excel, and digital filing systems.

COMPETENCIES: (Knowledge, Skills and Abilities)

· Accountability

· Integrity

· Efficiency

· Customer Orientation

· Adaptability

· Proactiveness

Work Location: In person