Claims Coordinator

St. Peregrine Surgical and Cancer Center; Philippines; On-site; PHP 300,000 - 420,000; Full time

Job summary

St. Peregrine Surgical and Cancer Center seeks a Claims Coordinator to manage end-to-end patient billing and claims processing, including PhilHealth and HMOs.

You will ensure accurate billing, timely submissions, and compliant documentation while coordinating with clinical and administrative staff. Based in Quezon City with fieldwork at PhilHealth Office and training at East Avenue Branch, this full-time role requires attention to detail and knowledge of payer guidelines to optimize

Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Nursing, or related field.
• Experience in hospital billing and claims processing (PhilHealth and HMO).
• Knowledge of PhilHealth guidelines, case rates, and documentation requirements.
• High attention to detail and accuracy.
• Willing to do fieldwork in PhilHealth Office.
• Willing to be assigned at Mega One Building, España Blvd. corner Mayon St., Brgy. Sta. Teresita, Quezon City.
• Willing to be trained at East Avenue Branch.

Responsibilities

• Prepare accurate patient billing for inpatient and outpatient services.
• Ensure proper charging of procedures, medications, supplies, and professional fees.
• Verify patient eligibility, benefits, and coverage prior to billing.
• Coordinate with medical and administrative staff for complete and accurate charge capture.
• Prepare, review, and submit claims to PhilHealth and HMOs with complete documentation.
• Ensure compliance with PhilHealth case rates, policies, and required forms.
• Process HMO claims, including validation of Letters of Authorization (LOA).
• Monitor claims status and follow up on pending, returned, or denied claims.
• Maintain accurate and organized records of all billing and claims transactions.
• Track reimbursements from PhilHealth and HMOs.

Skills

Attention to detail

Billing experience

PhilHealth knowledge

HMO knowledge

Education

Bachelor's degree in Business Administration, Healthcare Administration, Nursing, or related field

Job description

About the role

The Claims Coordinator is responsible for the end-to-end management of patient billing and claims processing, including submission to PhilHealth and various Health Maintenance Organizations (HMOs). The role ensures accurate billing, timely claims filing, compliance with regulatory and payer requirements, and efficient collection of reimbursements.

Key responsibilities

• Prepare accurate patient billing for inpatient and outpatient services
• Ensure proper charging of procedures, medications, supplies, and professional fees
• Verify patient eligibility, benefits, and coverage prior to billing
• Coordinate with medical and administrative staff for complete and accurate charge capture
• Prepare, review, and submit claims to PhilHealth and HMOs with complete documentation
• Ensure compliance with PhilHealth case rates, policies, and required forms
• Process HMO claims, including validation of Letters of Authorization (LOA)
• Monitor claims status and follow up on pending, returned, or denied claims
• Maintain accurate and organized records of all billing and claims transactions
• Track reimbursements from PhilHealth and HMOs

About you

• Bachelor's degree in Business Administration, Healthcare Administration, Nursing, or related field
• Experience in hospital billing and claims processing (PhilHealth and HMO)
• Knowledge of PhilHealth guidelines, case rates, and documentation requirements
• High attention to detail and accuracy
• Willing to do fieldwork in PhilHealth Office
• Willing to be assigned at Mega One Building, España Blvd. corner Mayon St., Brgy. Sta. Teresita, Quezon City
• Willing to be trained at East Avenue Branch