• Assure accurate insurance claims adjudication in a timely manner.
• Assure timely submission of invoices/claims utilization report.
• Validate documents received as well as members' information to adjudicate the Claims based on the submitted information.
• Apply the Plan policy and its exclusion as well as underwriting guidelines to determine coverage for claims.
• Deny claims according to SOB, exclusions and policies.
• Assure timely payment of invoices from providers and ensure all information and documents needed are accurate and complete.
• Keep management aware of members' issues from providers to enhance operations and escalate to the higher-ups when necessary.
• Coordinate with providers all Claims unpaid and do reconciliation.
• Answer inquiries and handle complaints from providers.

• In charge inInventory checking only for program ideas
• In charge in Technical Product Relayed(Specification of product)
• In charge Ordering of products participation
• In charge in promoting, strategizing and to market the products to Sales Specialist.
• To be knowledgeable with products and properly detail, demonstrate or conduct presentation to the client.
• To be very knowledgeable and ready for continuous learning of all aspects of the products handled by the company.
• To be able to conduct simple troubleshooting with the products being handled.
• To be able to communicate and convey all important aspects of the product to the client.
• To organize events and product presentations or demonstration.
• In charge in generating necessary reports required such as, but not limited to, reimbursements, sales activities, forecasts and sales strategies.
• Creative, collaborative and must coordinate with colleagues to ensure the success of the company. In charge in helping Credit & Collection to collect & follow-up accounts.
• Attend other task assigned by the Sales Officers from time to time.

A Patient Care Coordinator - PHRN is responsible for managing and coordinating patient care services by facilitating communication between patients, healthcare providers, and insurance companies. This role includes scheduling appointments, managing referrals, ensuring timely follow-ups, and maintaining accurate patient records in compliance with regulatory standards. The Patient Care Coordinator also provides support and guidance to patients regarding their care plans, treatments, and insurance processes, while advocating for their needs. Strong communication, organizational skills, and the ability to work efficiently in a fast-paced environment are essential, along with an active PHRN license and knowledge of healthcare procedures and medical terminology.

Work Setup:

• Onsite - Taguig
• Weekends off

Salary:

• Up to ₱34,000 per month
• 10% Night Differential (ND)
• HMO coverage starting Day 1 with dependent
• 13th-month pay

• Engages and maintains existing and potential clients on a regular basis through personal visits and other communication means ensuring requirements, concerns and issues are being met.
• Strengthens relations with clients for the development/acceptance, use, and sales growth of products being handled.
• Provides client reports with updated key personnel, volume requirements, current state of sales, and action plans that may lead to new development or increase current sales.
• Prepares and issues price updates and quotations to clients on a timely manner.
• Supports the business unit through collection of necessary documents, filing of forms, following up progress update on customer evaluation, and coordination with different departments for client accreditation.
• Develops and recommends marketing and sales objectives, detailing sales volumes and profit forecasts for each product range under their respective unit.
• Gives feedback on market trends, competitor moves, and industry landscape of the product unit.
• Develops and recommends sales strategies and programs to improve sales for the Group or Unit.
• Attends to customer complaints and clients’ logistical issues and suggestion relative to covered products and unit sales operations as part of after sales service.
• Performs such other duties as may be delegated by the superior.

• Overseeing ancillary service operations and staff management.
• Ensuring compliance with healthcare regulations.
• Coordinating training programs for support staff.
• Streamlining processes to improve patient care.
• Collaborating with healthcare providers and administrators.

• Answer Incoming calls and also make outbound calls.
• Ensure that right patient is identified before disclosing information
• Listen to Customer queries and resolve and provide solutions, if unable to resolve, have the same escalated to the supervisors If Insurance query, respond appropriately, also obtain relevant missing info from the patient so that claim can be processed
• Understand and handle disputes
• Detailed Documentation
• Efficient Call Handling Time
• Potential Follow Up Methods Payment in Full and Partial Payment discussions
• Understand difference between dispute & objection
• Effective rate of speech - good communication & neutral accent Obtain Insurance details from patients
• Obtain Additional Info - Referral Information / PCP information, etc.
• Call for accidental Information like DOA Demographic details/ Mismatch in Name and DOB
• Update patient about their out-of-pocket expenses
• Obtain WC details, Injury Date COB Update/ABN/AOB pending
• Appointment Scheduling, Appointment Cancelation, Appointment Reminder

Secondary Roles Responsibilities:

• Maintain professional decorum and punctuality
• Plan leaves well in advance
• Ensure good interpersonal relation is maintained while coordinating

Compliance

• Ensure privacy and security in the operation and in the operation area that includes work from office and home.
• Ensure you have acknowledged all the Organizational policies as per HR Procedure
• Ensure you are attending the Compliance awareness and refresher sessions & other security training programs as per L&D Procedure
• Ensure you are aware of agreed SLA of the projects you are working.
• Follow all the Information security guidelines
• Report any Security & Privacy incidents to your reporting manager/ HR/Compliance Team/CISO
• Ensure Confidentiality, Integrity & Availability of Data/information you handle
• Adhere to the NDA & confidentiality Agreement
• Adhere to the Micro Company's CISO's roles & responsibilities if you are a Micro Company Compliance SPOC

Assist healthcare professionals in providing patient care, supporting daily operations, and maintaining a safe and clean environment.

Reporting daily

• Develop and optimize food products for safety, quality, and compliance.
• Conduct research on food ingredients and processes.
• Collaborate with production teams to enhance product consistency.
• Ensure compliance with health and safety regulations.
• Stay updated on industry trends and innovations.

• Assigns diagnosis codes according to the Official ICD-10-CM Guidelines for Coding and Reports for conditions which map to the Center for Medicare & Medicaid Services’ Hierarchical Condition Categories (CMS-HCC) applicable for the year(s) of service being reviewed
• Conducts thorough review of charts by effectively using computer-assisted coding tools to review and interpret medical records, and applies in-depth knowledge of coding principles to assign valid diagnosis codes which are supported by evidence in the medical record on the same date of service
• Demonstrates knowledge of what constitutes a medical record acceptable for supporting CMS-HCCs, including signature guidelines, member identifiers, provider types, medical record encounter/visit types, and places of service
• Demonstrates advanced knowledge of medical terminology, anatomy and physiology as they pertain to assigning appropriate codes and identifying pertinent supporting information in the medical record
• Manages individual quality of work & productivity toward meeting or exceeding targets.
• Performs administrative tasks and work as directed by Team Lead/Operations Lead/Quality Lead.
• Consults Team Lead/Operations Manager and/or Coding SME timely and appropriately.

• Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.
• Verify member eligibility and benefits coverage for submitted claims.
•  Evaluate medical documentation to assess the appropriateness of services rendered and coding accuracy.
• Adjudicate claims accurately and efficiently within established turnaround times.
•  Identify and investigate potential fraudulent or abusive billing practices.
• Communicate claim decisions, payment details, and denials to providers and members effectively.
• Collaborate with other departments, such as Provider Relations and Customer Service, to resolve claim-related issues and inquiries.
• Maintain comprehensive and organized claim records, documentation.

• Examines patients and treats injuries within the scope of training and/or refers patients to appropriate practitioner or clinic or arranges for transport to local hospital.
• Provides standard first aid treatment for injuries not considered serious, which may include cleaning injured areas and applying antiseptic, salves, ointments, or bandages.
• Observes staff with injuries or illnesses requiring further treatment.
• Maintains required records and documentation including log of injuries and occupational illnesses requiring first aid treatment.
• Maintains adequate inventory of first aid supplies; requests additional supplies when needed.
• Maintains neat and tidy first aid room.
• Performs other related duties as assigned.

Elevate Your Career as a 2D Echo Technologist at PCC Alabang Mega Clinic!

Are you a dedicated healthcare professional who is passionate about delivering exceptional patient care? Your next rewarding career opportunity is here! PCC Alabang Mega Clinic is seeking a skilled 2D Echo Technologist to join our innovative team.

In this vital role, you’ll use your expertise to perform high-quality echocardiograms that are crucial for accurate diagnoses and effective treatment plans. Your compassionate approach will help create a comforting environment for patients, ensuring they feel valued and cared for during their visit.

• Perform 2D echocardiogram with a focus on accuracy and quality.
• Utilize advanced equipment to capture detailed cardiac images.
• Foster a welcoming and comforting environment for patients undergoing echocardiograms.
• Prioritize patient well-being and address concerns with empathy.
• Efficiently process echo images to generate comprehensive reports.
• Communicate results to patients with clarity and compassion, ensuring a positive understanding.

• Addresses members' concern regarding their benefits.
• Issues benefit reference and LOAs to the accredited providers based on turn-around time.
• Screens and process medical reimbursement.
• Attends to customer service requests from mobile app and chats.

Maintain accurate records of all billing activity of assigned corporate medical accounts. Compute for appropriate value added tax (VAT) and input tax. Reviews and Endorse billing in accordance with the existing health insurance policy of the assigned accounts. Identifies outstanding debts. Communicates with clients about past dues payments. Resolves billing and customer credit issues. Facilitates and monitor collection from accounts.

• Monitor and optimize production processes to ensure efficiency and quality.
• Implement process improvements to reduce waste and improve productivity.
• Ensure compliance with food safety and quality standards.
• Analyze process data and provide reports for management decision-making.
• Collaborate with cross-functional teams to resolve production issues.
• Conduct routine checks and maintenance of equipment to ensure smooth operations.