Claims Processor
Claims Processor
JOB DESCRIPTION
JOB SUMMARY
- Receives and processes bills from hospitals, doctors, dentists
DUTIES & RESPONSIBILITIES
- Receives daily bills from MediCard Claims Receiving Clerk. Receiving copy must be returned to MediCard within the day. Files Receiving Summary per hospital/doctor.
- Encodes info to the CPS. Verifies benefits and limitations through MediCard Intranet Solutions. Determines the amount to be paid. Amount and number of patients should tally with the billing from the hospital.
- Make sure that all hospital bills must have LOA or approval number in order to validate approved and disapproved charges. A special accommodation form/letter must be attached for any special arrangement made by the MediCard Medical Operations Department/Customer Management Department with regard to the approval of hospital rates, professional fees and other accommodation extended to our members.
- Print and attach utilization report for all in-patient and dental services. For out-patient consultations and medical services, a utilization report shall be attached to the bills for checking of the pre-existing conditions and dreaded diseases and other illnesses whenever necessary.
- Submits processed bills to MediCard Jr. Supervisor/Assistant Supervisor and Medical Administrator for checking and approval.
- Make sure that all advances/cost + accounts be billed by the MediCard Billing Clerk. All disapproved charges/accommodations extended to our employees and agents must have a corresponding Debit Memo (DM).
- Effect corrections, if any, and print final HBA, Summary of OP, DT and Med. Services. Forward processed/approved bills to MediCard A/P Clerk for check preparation.
- Submits Daily Processed Report and Weekly Status Report to Claims Jr. Supervisor/Assistant Supervisor.
- Maintains file for Daily Processed Report/Receiving Summary, Action Memos, Incident Reports, Logbooks and other pertinent documents.
- Makes sure that all bills received be processed within 5 days and be paid on or before their due dates.
- Attends to all inquiries of medical providers (hospitals and doctors) regarding unpaid bills.
- Delivers check payments to the assigned medical providers if necessary.
- Performs other related tasks that may be assigned from time to time.
JOB QUALIFICATION
QUALIFICATIONS AND GUIDELINES
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· Education |
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Graduate of any 4-year business course preferably Accounting |
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· Experience |
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At least one year experience in a clerical position |
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· Other Skills |
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Good filing and coding skills. Computer literate |
OTHER JOB REQUIREMENTS
JOB BENEFITS
OthersWORK LOCATION
MakatiCOMPANY PREVIEW
Dress Code
Language
Telephone No.
Mobile No.
Company Size
COMPANY OVERVIEW
MediCard Philippines, Inc. was incorporated in December 1986 and formally inaugurated on May 15, 1987 to provide comprehensive healthcare coverage to individuals in Metro Manila as well as in key provincial areas. The company was conceptualized by a group of eminent physicians who saw the need of making healthcare as accessible as possible to many Filipinos. As specialists in their own respective fields, they saw healthcare can be elusive to ordinary people because of limited healthcare programs that could benefit as many Filipinos as possible. As the cost of healthcare continues to rise every year, more and more people cannot afford even routine check-ups in hospitals and even doctors’ clinics.
From a company that started servicing only individuals and families, it has evolved to a company who is health provider to big multi-national and Filipino-owned corporations. MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement. To target more Filipinos, MediCard also introduced RxER, Health Plus and Health Check Cards.
Even Filipinos working abroad can now have peace of mind by giving health protection to their loved ones in the Philippines through MediCard Kabayan. Since its inception, MediCard has always been guided by a service-oriented culture being the only HMO founded and managed by doctors. This differentiates it from the vast competition, alongside providing innovative schemes that cut down the cost of health maintenance without compromising quality. In fact, MediCard has maintained its position being a leading HMO in the country as it remains among the Top 3 HMOs in the Philippines and Top 500 corporations in the Philippines.