Claims Officer

The Claims Officer is responsible for acquiring reparations for Philhealth claims, submission, and reviewing the eligibility of the guest in all aspects.

SPECIFIC DUTIES AND RESPONSIBILITIES

1. TECHNICAL

· Regularly secure and safe keep / organize the guest’s documents in proper filing

· Perform a detailed review of the accuracy and completeness of PHIC documents received from guests

· Revalidates the Accreditation validity period of the attending Nephrologist per guest.

· Facilitate the registration of the guests to the PDD portal

· Revalidates that the guest’s PDD registration is still active in the PDD portal prior to the guest’s first use of PHIC benefits in NHCSPI.

· Checks the accuracy of the guest’s date of treatment versus in the Hemodialysis treatment sheet.

· Timely perform generation of PHIC claims for each guest according to NHCSPI’s internal deadline

· Arrange, properly, and accurately accomplish and attach the guest’s PHIC documents to E-Claims

· Responsible for reviewing the encoded data in E-claims before transmitting.

· Timely and completely notify the Support Office - AR Team for RTH/ Denied notices received by PHIC thru Erth (electronic RTH system) or physical.

· Timely and accurately re-file RTH/ Denied claims.

· Can draft appeal letters/explanation letters to support RTH / Denied claims, subject to review and approval by Account Receivable Manager.

· Maintain updated data in PHIC Monitoring with PHIC Database, Tracker, Monthly sheet, and other monitoring and reportorial documents.

· Submit on a weekly basis to PHIC the Official Receipt for collections deposited by PHIC thru Auto credit payment.

2. ACCOUNTABILITIES

· Ensure Claims processing including but not limited to RTH/Denied filings is ACCURATE.

· No fraud details including not limited to session date/s and total number of treatments

· Avoid the reason of claims that can be caused by PHIC Accreditation Suspension “Double Filling”, “Fraud claims”, etc.

· All unpaid claims that result in uncollectible claims due to your negligence will be subjected to a charge.

Requirements:

With 6 months to 1 year experience

Graduate of any 4 years course

Willing to work in Makati City

Willing to render overtime if needed.

Hardworking, independent and reliable