Hospital Admissions & Insurance Claims Specialist

KPJ Healthcare Berhad; Kuala Lumpur; On-site; MYR 36,000 - 58,000; Full time

Job summary

KPJ Healthcare Berhad in Malaysia is seeking an Healthcare Administration Officer to manage patient guarantee letters and related documentation during admission and pre-admission processes. You will coordinate with Insurance companies, MCOs, and corporate clients, ensure completeness of forms, update system records, and deliver courteous support to patients throughout their hospital stay.

The role requires adherence to hospital policies, accreditation standards, and safety regulations, with

Responsibilities

• Obtain initial guarantee letters for patients admitted to hospital using Insurance, MCO and Corporate Companies.
• Update guarantee letter status in HITS, BMS, Care Tracker and Pro Bridge system and notify patient and consultant.
• Ensure completeness of claim forms and other relevant documents received.
• Respond to deferment/medical questionnaire highlighted by MCO and Insurance companies.
• Obtain approval from Insurer for referral consultant and add-on procedure during admission (recorded at Pro Bridge).
• Upload/email complete documentation for pre-admission and outpatient visits guarantee letters.
• Responsible for top-up guarantee letters requested by patients following the initial guarantee letter limits.
• Obtain the credit limit or coverage for patients admitted to hospital from MCO and Insurance companies.
• Verify guarantee letters for outpatient patients before proceeding to see consultants.
• Provide courteous service to all patients during admission.
• Carry out duties as assigned by superior and HOS, and adhere to safety regulations (OSHA 1994).
• Participate in new services introduced and ensure Patient Safety goals are followed as per World Alliance for Patient Safety (2008).
• Adhere to Hospital policies, accreditation standards, and ISO framework (ISO 9001:2015, ISO 14001:2015, ISO 45001:2018).

Job description

KPJ Healthcare Berhad in Malaysia is seeking an Healthcare Administration Officer to manage patient guarantee letters and related documentation during admission and pre-admission processes. You will coordinate with Insurance companies, MCOs, and corporate clients, ensure completeness of forms, update system records, and deliver courteous support to patients throughout their hospital stay.

The role requires adherence to hospital policies, accreditation standards, and safety regulations, with