job description
Are you driven by compassion and a commitment to excellence? Allied Care Experts is seeking a dedicated and detail-oriented HMO Staff to join our growing healthcare team in Mandaluyong City. At the core of our operations lie the values of Altruism, Compassion, and Excellence. We are looking for an individual who is passionate about delivering top-tier administrative support to ensure seamless healthcare experiences for our patients.
As an HMO Staff member, you will serve as a vital bridge between our hospital services and Health Maintenance Organizations. Your work will directly impact the patient journey by facilitating efficient processing, accurate billing, and clear communication. If you are mission-driven and thrive in a fast-paced medical environment where quality service saves lives, we want you on our team.
Responsibility
- Manage the verification and processing of patient HMO/Health Insurance documents.
- Coordinate with various HMO providers regarding Letter of Authorization (LOA) requests and patient eligibility.
- Maintain accurate and organized medical billing records and insurance claims databases.
- Provide front-line support to patients, addressing inquiries regarding their HMO coverage and benefits.
- Collaborate with clinical and billing departments to resolve claim discrepancies or rejected billing submissions.
- Prepare daily, weekly, and monthly reports on HMO utilization and pending accounts.
- Ensure compliance with hospital policies and data privacy regulations (Data Privacy Act).
Qualifications
- Bachelor’s degree in Healthcare Management, Nursing, Business Administration, or any related field.
- At least 1-2 years of experience in HMO processing, medical billing, or insurance coordination in a hospital setting.
- Strong understanding of healthcare insurance procedures and ICD-10 coding basics.
- Excellent communication and interpersonal skills, with a compassionate approach to patient care.
- Highly proficient in Microsoft Office (Excel, Word) and Hospital Information Systems (HIS).
- Ability to multitask and maintain accuracy under pressure in a fast-paced environment.
- Demonstrates a strong sense of altruism and dedication to mission-driven healthcare services.