Assistant Manager - Hospital Liaison

iCare HMO; Makati; On-site; PHP 360,000 - 600,000; Full time

Job summary

iCare HMO in Metro Manila seeks a dedicated Health Liaison Officer to monitor confinements of members in accredited facilities, answer queries, and ensure compliance with evolving policies.

You will collaborate with hospital staff, review charges and LOAs, support discharge planning, and help optimize member benefits while upholding company standards in Health & Safety and Quality Assurance.

Responsibilities

• Ensure proper monitoring of confinements of iCare members in accredited medical facilities.
• Address members’ queries, concerns and complaints promptly before elevating to the HLO Head.
• Keep abreast with regulations affecting medical services and provide proper guidance.
• Be up to date on medical updates, utilization management, newly onboarded and renewed account benefits.
• Maintain company spiels and lines to entice members to discuss benefits including LOA issuances.
• Visit admitted members to discuss coverage and benefits and issue LOA.
• Monitor daily the member’s progress chart to assess needs and current medical condition.
• Assist the member during discharge by checking hospital charges and professional fees to maximize benefits.
• Build rapport with iCare’s Hospital Care Director and accredited doctors and provider staff.
• Visit hospital administrators and doctors to address concerns (unpaid claims, payments, and policies).
• Assist in creating processes to ensure alignment with Health & Safety, QA, Marketing & Brand, and Risk management policies.
• Ensure gatekeeping and utilization management through: validity of member status, benefit coverage and LOA issuance from MAS; case review; coordination of catastrophic cases for case management.
• Distribute service evaluation surveys and ensure targeted confidence level and margin of error monthly.
• Receive comments, suggestions and feedback and collate survey results.
• Assist Provider Management by increasing the roster of accredited facilities and physicians; accreditation of providers as needed; updating physician records; releasing documents as required.
• Coordinate with accredited facilities for payment, follow-ups, or lifting suspensions.
• Work with internal and external leaders affecting department operations.
• Contribute to create processes for Medical Audit and ensure proper application.
• Participate in process reviews and development of new work processes and policies relating to Utilization Management.

Job description

JOB DESCRIPTION

1. Ensure the proper monitoring of confinements of iCare members in accredited medical facilities.

2. Ensure that members’ queries, concerns and/or complaints are attended to in a timely and appropriate manner prior to elevating this to the HLO Head.

3. Keep abreast with current regulations and policies affecting medical services and implementation and provide proper guidance to all concerned.

4. Be up to date on medical updates, utilization management, newly onboarded and renewed account benefits.

5. Maintain company spiels and lines that will entice members to approach him/her regarding their benefit including medical network inquiries, concerns and LOA issuances

6. Visit admitted members ensuring to discuss the member’s coverage and benefits and issue the letter of authorization (LOA).

7. Monitor daily the member’s progress chart to know member’s needs and current medical condition.

8. Assist the member during discharge by checking hospital charges and professional fees to maximize member’s benefits and to prevent incurrence of excess charges beyond the benefit coverage and advise member on non-covered charges.

9. Build and maintain good rapport with iCare’s designated Hospital Care Director (HCD) in the hospital, iCare’s roster of accredited physicians and provider personnel.

10. Visit hospital administrators, HCDs and iCare- accredited doctors to act promptly on their concerns (i.e., unpaid claims, distribution of checks, implementation of new hospital policies, etc.).

11. Assist in creating and organizing processes, information acquisition and appropriate agreements to ensure alignment with the company's policies on Health & Safety, Quality Assurance, Marketing & Brand Management, and Risk & Integrity Management.

12. Ensure proper gatekeeping and utilization management through:

a. Determination of validity of the member status, benefit coverage and maximum available limit prior issuance of LOAs through information garnered from the Medical Account System (MAS).

b. Review of cases and checking necessity for confinement and need for medical procedure.

c. Coordination of catastrophic cases to superior for case management.

13. Distribute service evaluation survey forms and ensure that the targeted confidence level and margin of error is met on a monthly basis.

14. Receive comments, suggestions and feedback and collates survey results.

15. Assist the Provider Management Division by:

a. Increasing the roster of accredited medical facilities especially physicians.

b. Do on the spot or provisional accreditation of member accessed/requested physicians and/or medical facilities.

c. Updating the records of physicians as the need arises.

d. Collecting and/or releasing documents to and from accredited medical facilities.

e. Coordinating with accredited medical facilities for payment, OR follow-ups or lifting of suspensions.

16. Work with internal and external leaders in areas affecting department operations.

17. Contribute to create processes for Medical Audit and ensure proper application through an established and agreed medical audit exercise.

18. Participate in current process review and development of new and / or revised work processes, policies and procedures relating to Utilization Management responsibilities.

19. Submit reports relative to duties and responsibilities.