Patient Relations Officer 1 - Intellicare

Asalus Corporation (IntelliCare); Makati; On-site; PHP 201,000 - 290,000; Full time

Job summary

Asalus Corporation (IntelliCare) is seeking a healthcare administration professional to delight customers with quality service during confinement, ensuring SLA and benefit plan implementation. The role covers admission, benefit explanations, and discharge coordination, within an office-based setting in Makati.

You will collaborate with physicians and hospital staff to ensure smooth patient experiences, monitor stay lengths, and handle confidential information with care.

Qualifications

• Graduate of a 4-year allied medical course, preferred.
• Experience or familiarity with HMO settings is an advantage.
• Ability to work on flexible schedules and on-call shifts.

Responsibilities

• Assist patient admission within 24 hours in key cities and 48 hours for provincial hospitals.
• Discuss health plan benefits, coverage and limitations with members.
• Coordinate with physicians and departments to reconcile claims and coverage.
• Ensure confidential handling of member information at all times.
• Monitor length of stay and assist discharge to collect non-coverable charges.
• Respond to urgent endorsements and maintain professional communication with hospital staff.

Skills

Oral communication

Written communication

Computer literacy

Education

Graduate of 4yr allied medical course

Job description

JOB PURPOSE

To delight customers by providing quality service through personalized assistance of members during confinement and ensure proper implementation of the service level agreement and benefit plan of the members.

DUTIES & RESPONSIBILITIES

To ensure and manage hassle free customer experience from admission up to discharge

• 1. Assist patient’s admission within 24 hours for key cities and within 48 hours for provincial hospitals.
• 2. Informs and negotiates with attending physician regarding application of RVs on professional fees and compliance.
• 3. Discuss health plan benefit, coverage and limitations.
• 4. Informs confined member pertinent documents needed to be accomplished upon discharge.
• 5. Assist the patient in signing all documents needed prior release of coverage.
• 6. Monitors and re-visits currently confined patients.
• 7. Assist VIP’s during confinement and ecu, ape and out-patient availment once FCSS 1 is not available.
• 8. On-call and to respond to urgent endorsements, calls or messages received beyond office hours.
• 9. Coordinates with the claims processing and finance dept regarding reconciliation of unpaid billings of hospitals and or doctors to help prevent suspension.
• 10. May act as reliever to other functions required as deemed necessary
• 11. Cases of patients should be kept confidential at all times. No divulging of information unless the doctor will do so.
• 12. Seek approval regarding member’s confinement from the team leader or supervisor prior release of RCS 3 for confinements beyond their level of authority.

To manage customer expectations regards to benefit coverage, proper handling customer complaints encountered during confinement. To build customer trust and satisfaction and further enhancing loyalty.

• 1. Informs and negotiates with attending physician regarding application of RVs on professional fees and compliance. To escape to medical group for any accredited doctor doing balance billing.
• 2. Reports any member / patient who exceeded limit for account officers' information.
• 3. Reports to office at least once a week for updating and completion of documents to be attached to SOAs prior endorsement to claims department

To ensure implementation of cost management initiatives in all confined patients and to contribute to the overall bottom line of the company.

• 1. Regular monitoring of length of stay of confined members and monthly reporting of updates in their respective areas of assignment. Report to medical group any accredited doctor with longer length of stay.
• 2. Steerage cost efficient facilities and implementation of the packages.
• 3. Establish rapport with the hospital staff and accredited specialist / coordinators.
• 4. Assist patient during discharge to ensure all non-coverable charges are collected from the patient.
• 5. Tag complete discharge details in the system within the required tat within one week after patient’s discharge.
• 6. Coordinates with hospital coordinators and accredited doctors regarding patient’s health status and concerns.

To prevent fraud and abuse of the members, doctors, and facilities.

• 1. Review statement of accounts of covered members for double billing and unusual charges prior to discharge.
• 2. To escape to medical group any unusual charges seen in the statement of accounts for proper handling.
• 3. Tag details of confinement in the system. Checks member’s data & benefit for proper tagging and documentation.
• 4. Reports to office at least once a week for updating and completion of documents to be attached to SOAs prior endorsement to claims department.

QUALIFICATIONS

Educational requirement

Graduate of 4yr course preferably allied medical courses

Relevant work experience

Experience in an hmo setting an advantage but not required

Personal characteristics and behaviors

Ability to adjust to flexible schedules or to work on call.

With pleasing personality, good moral character.

Required competencies and proficiency levels

Good in oral & written communication skills, computer literate.

NOTE Office Address: Ground Floor, Feliza Building, 108 V.A. Rufino St., Legaspi Village, Makati City

Work Setup: Office-based during training. Work arrangement after training (office-based or fieldwork) will be determined based on operational requirements and manpower needs.