PhilHealth Claims Processing Staff

About the role

The PhilHealth Claims Processing Staff is responsible for preparing, reviewing, submitting, monitoring, and following up on PhilHealth claims for patients availing of hospital and rehabilitation services. The role ensures that claims are accurate, complete, properly documented, and submitted within the prescribed deadlines in compliance with PhilHealth policies and hospital procedures.

Key responsibilities

• Review and verify patient information, PhilHealth eligibility, and required supporting documents.
• Prepare and process PhilHealth claims, ensuring the completeness and accuracy of medical records and billing documents.
• Coordinate with physicians, physical and occupational therapists, medical records staff, billing personnel, and other concerned departments regarding missing or incomplete requirements.
• Monitor and follow up on pending, returned, denied, or questioned claims and coordinate necessary corrections.
• Maintain organized records and updated monitoring reports for submitted, pending, returned, denied, and paid claims.
• Assist in preparing reports, reconciling PhilHealth payments, and providing documentation for internal and external audits.
• Ensure the confidentiality and security of patient information and compliance with PhilHealth regulations and hospital policies.

About you

• A bachelor's degree in Healthcare Administration, Medical Technology, Nursing, Physical Therapy, Occupational Therapy, Medical Records, Business Administration, or a related field is preferred.
• Experience in hospital billing, medical records, PhilHealth claims processing, health insurance processing, or healthcare administration is an advantage.
• Knowledge of medical terminology, claims documentation, and basic computer applications is preferred.
• Strong attention to detail, organizational skills, accuracy, and effective communication and coordination skills.