Claims Coordinator

St. Peregrine Surgical and Cancer Center; Quezon City; On-site; PHP 279,000 - 446,000; Full time

Job summary

The Claims Coordinator at St. Peregrine Surgical and Cancer Center will manage end-to-end patient billing and claims processing, including PhilHealth and HMO submissions.

The role ensures accurate billing, timely filing, regulatory compliance, and efficient collection of reimbursements. Responsibilities include billing management, claims processing, documentation, collections, reconciliation, and reporting.

Qualifications

• Bachelor’s degree in Business Administration, Healthcare Administration, Nursing, or related field.
• Experience in hospital billing and claims processing (PhilHealth and HMOs) is an advantage.
• Knowledge of PhilHealth guidelines, case rates, and documentation requirements is an advantage.
• High attention to detail and accuracy is a must.
• 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

• Billing Management: Prepare accurate patient billing for inpatient and outpatient services.
• Claims Processing (PhilHealth & HMOs): Prepare, review, and submit claims with complete documentation.
• Coordination & Documentation: Maintain accurate records and coordinate with patients, providers, and insurers.
• Collections & Reconciliation: Track reimbursements and reconcile payments against submitted claims.
• Compliance & Reporting: Ensure adherence to regulations and prepare reports on claims status and denials.

Skills

Attention to detail

Billing knowledge

Regulatory compliance

Documentation

Fieldwork

PhilHealth knowledge

Education

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

Job description

Job Summary:

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:

1. Billing Management

• 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

2. Claims Processing (PhilHealth & HMO)

• 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
• Handle corrections, resubmissions, and appeals

3. Coordination & Documentation

• Maintain accurate and organized records of all billing and claims transactions
• Coordinate with patients, healthcare providers, and insurance representatives
• Ensure completeness of medical records and supporting documents
• Address inquiries related to billing and claims

4. Collections & Reconciliation

• Track reimbursements from PhilHealth and HMOs
• Reconcile payments against submitted claims
• Monitor accounts receivable and aging of claims
• Assist in resolving discrepancies in payments or denials

5. Compliance & Reporting

• Ensure adherence to government regulations, HMO requirements, and internal policies
• Prepare regular reports on claims status, billing accuracy, denials, and collections
• Identify issues and recommend process improvements

Qualifications

• Bachelor’s degree in Business Administration, Healthcare Administration, Nursing, or related field
• experience in hospital billing and claims processing (PhilHealth and HMO) is an advantage
• Knowledge of PhilHealth guidelines, case rates, and documentation requirements is an advantage
• High attention to detail and accuracy is a must
• 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.