PhilHealth & HMO Officer

Japan Eye Center Inc.; Philippines; On-site; PHP 201,000 - 335,000; Full time

Job summary

Japan Eye Center Inc. is seeking a Claims Processing Specialist to manage end-to-end PhilHealth and HMO claims for the clinic.

You will verify eligibility, prepare and review documents, and submit claims within deadlines. You will monitor claims status, coordinate with PhilHealth, HMO providers, physicians, nurses, and billing staff, and maintain accurate records of submitted and denied claims to support timely reimbursement.

Qualifications

• Knowledge of PhilHealth policies and HMO claim requirements.
• Experience in medical billing and records management.
• Strong attention to detail and ability to coordinate with multiple teams.

Responsibilities

• Verify patient eligibility and benefits.
• Prepare and review claim documents.
• Ensure completeness and accuracy of medical and billing records.
• Submit claims within prescribed deadlines.
• Monitor claims status until payment or final resolution.
• Coordinate with PhilHealth, HMO providers, physicians, nurses, billing personnel, medical records staff, and patients regarding claim requirements.
• Identify incomplete or incorrect documentation.
• Facilitate correction of deficiencies.
• Follow up on outstanding claims.
• Maintain accurate records of submitted, pending, paid, returned, and denied claims.

Skills

PhilHealth claims processing

HMO coordination

Medical billing

Record keeping

Job description

About the role

Responsible for the end-to-end processing and monitoring of PhilHealth and HMO claims of the clinic. This includes verifying patient eligibility and benefits, preparing and reviewing claim documents, ensuring completeness and accuracy of medical and billing records, submitting claims within prescribed deadlines, and monitoring claims status until payment or final resolution.

Key responsibilities

• Verify patient eligibility and benefits

• Prepare and review claim documents

• Ensure completeness and accuracy of medical and billing records

• Submit claims within prescribed deadlines

• Monitor claims status until payment or final resolution

• Coordinate with PhilHealth, HMO providers, physicians, nurses, billing personnel, medical records staff, and patients regarding claim requirements, deficiencies, approvals, denials, and other concerns

• Identify incomplete or incorrect documentation

• Facilitate the correction of deficiencies

• Follow up on outstanding claims

• Maintain accurate records of submitted, pending, paid, returned, and denied claims

About you

• Ensure all claims are processed in accordance with PhilHealth policies, HMO agreements, clinic procedures, and applicable healthcare regulations

• Assist in preparing reports

• Monitor accounts receivable related to PhilHealth and HMO claims

• Provide management with updates regarding claim performance, outstanding receivables, denials, and other reimbursement concerns