Support Service Specialist - Medical Allied Course
Full-time
Growvite Staffing Services Inc
Qualifications
- Graduate of any medical-allied course (e.g., Nursing, MedTech, Psychology)
- Experience in HMO, healthcare, or customer service is an advantage
- Good communication skills (written and verbal)
- Comfortable handling inquiries via digital and social media platforms
- Basic knowledge of medical terms and procedures
- Computer literate and detail-oriented
- Willing to do occasional outbound calls to providers
Responsibilities
1. Customer Experience
- Initially acknowledges admission for the day through active call-out
- Closely monitors admissions in assigned/affiliated providers
- Creates case and authorization in One System; updates discharge date within 24hrs
- Calls admitted member and reorients benefit plan and requirements during admission; ensures understanding through acknowledgement of explanation if visit is not applicable
- Opportunity to expand services to attend members via hospital visits within hospital protocols
- Assesses availment and issues Letter of Authorization accordingly to billing/credit and collection
- Closely monitors member’s confinement progress through regular inquiry from available nurses on duty
- Calls member and attending physician whenever necessary
- May assist member during discharge to ensure proper computation and collection of uncoverable charges
- Captures provider issues such as unpaid claims, implementation of new hospital policies, threat of suspensions, etc.
- Establishes good working relationship among affiliated providers
2. Utilization Management
- Reviews and analyzes cases of admission; checks necessity of the confinement and/or procedure
- Reviews and reports member’s Length of Stay (LOS) and cost of confinement and/or procedure
- Coordinates complex/catastrophic cases to superior or Medical Resource for proper management
- Approves coverage based on authority limit up to P50,000; otherwise refers to authorized approver
- Reports denied admissions
3. Report Generation
- End of day report of admissions and discharge
- Updates the “endorsement to claims” in OS for claims’ reference
4. Others
- Performs other tasks as may be assigned from time to time
Vacancy posted 21 days ago
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