Junior Claims Officer

Golden Renal Care Holdings Inc.; Cainta; On-site; PHP 250,000 - 350,000; Full time

Job summary

Golden Renal Care Holdings Inc. seeks a Junior PhilHealth Claims Officer to assist in the preparation, submission, and monitoring of PhilHealth claims for dialysis patients.

You will ensure accurate documentation, comply with PhilHealth requirements, and support timely processing to contribute to the center’s revenue cycle. Collaborate with the Billing team and clinical staff to reconcile reimbursements, maintain secure records, and stay updated on PhilHealth circulars.

Qualifications

• Bachelor’s degree required in accounting, business admin, nursing, or related healthcare field.
• 1–2 years of experience in claims processing or healthcare billing (PhilHealth experience preferred).
• Proficiency in MS Office and healthcare billing systems.

Responsibilities

• Prepare PhilHealth claims with patient data, treatment logs, and supporting documents.
• Monitor submitted claims and follow up on status and denials.
• Ensure compliance with PhilHealth guidelines and dialysis-specific requirements.
• Coordinate with Billing, AR, and clinical staff to reconcile reimbursements and documentation.

Education

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

Tools

MS Office

Healthcare billing systems

Job description

Job Purpose

The Junior PhilHealth Claims Officer assists in the preparation, submission, and monitoring of PhilHealth claims for dialysis patients. This role supports the claims team by ensuring accurate documentation, compliance with PhilHealth requirements, and timely processing to contribute to the center’s revenue cycle.

Key Responsibilities

Claims Preparation

• Collect and organize patient treatment logs, medical records, and supporting documents for PhilHealth claims.
• Encode claim details into the PhilHealth system accurately and promptly.
• Assist in preparing claim forms and attachments for submission.

Monitoring & Follow-Up

• Track submitted claims and update records on claim status.
• Assist in following up with PhilHealth offices regarding pending or denied claims.
• Report discrepancies or issues to the Senior Claims Officer.

Compliance & Documentation

• Ensure claims comply with PhilHealth guidelines and dialysis-specific requirements.
• Maintain proper filing and secure handling of patient records and claim documents.
• Stay updated on PhilHealth circulars and benefit package changes.

Coordination

• Work closely with the Billing and Accounts Receivable team to reconcile reimbursements with patient accounts.
• Coordinate with clinical staff to ensure accurate documentation of dialysis sessions.
• Support audits by providing claims-related documentation when required.

Qualifications

• Bachelor’s degree in Accounting, Business Administration, Nursing, or related healthcare field.
• 1–2 years of experience in claims processing or healthcare billing (PhilHealth experience preferred).
• Basic knowledge of PhilHealth rules, benefit packages, and claims procedures.
• Proficiency in MS Office and healthcare billing systems.
• Strong attention to detail and organizational skills.

Key Competencies

• Accuracy and attention to detail.
• Good communication and interpersonal skills.
• Ability to work under supervision and follow established procedures.
• Integrity, confidentiality, and professionalism.
• Time management and ability to meet deadlines.