JOB SUMMARY:

The position is essentially responsible for effectively carrying out set strategies of the Customer Experience Division relevant to the confinement of valued members. It ensures customer satisfaction through effective rapport and proper utilization management.

DUTIES AND RESPONSIBILITIES:

1. CUSTOMER EXPERIENCE

• Always ensures efficient execution of the est-in-class Customer Experience for the assigned provider.
• Closely monitors admission/s in assigned/ affiliated providers
• Creates case and Authorization in One System; updates discharge date within 24hours
• Visits admitted member and reorients benefit plan and requirements during the admission, and ensures understanding through acknowledgement of the Visit Form
• Assesses availment and issues a Letter of Authorization according to billing/credit and collection
• Closely monitors members’ confinement progress through the patient’s medical chart
• Revisits the member whenever necessary.
• May assist the member during the discharge to ensure proper computation and collection of uncovered charges
• Captures provider issues such as unpaid claims, implementation of new hospital policies, threats of suspension,n,s etc.
• Establish a good working relationship/partnership among affiliated providers

2. UTILIZATION MANAGEMENT

• Reviews and analyzes cases of admission; checks the necessity of the confinement and/or procedure.
• Reviews and reports members’ Length of Stay (LOS) and Cost of confinement
• Coordinates complex/ catastrophic cases to the superior or Medical Resource for proper management
• Approves coverage based on authority limit up to P50,000; otherwise, shall refer to the authorized approver
• Reports denied admissions

3. REPORT GENERATION

• End-of-day report of admissions and discharges
• Updates the “endorsement to claims” in OS for Claim’s reference

QUALIFICATIONS:

• Graduate of any Medical allied courses,e preferably Nursing/ Physical Therapy
• Preferably with experience in the nHMO industry
• Must be willing to do field work at the assigned clinics/hospitals around the Cebu area