Claims Review Specialist

Claims Review Specialist

Job Category: Support Group
Job Type: Full Time
Job Location: Cebu City
Job Summary

Make a difference and advance your career with Chong Hua Hospital, the Philippines’ premier healthcare destination!

Chong Hua Hospital is looking to hire an experienced and highly motivated Claims Review Specialist who ensures that claims documents are in compliance with Philhealth circular and advisories. S/he ensures that there are no deficiencies, fraud, error on the submitted clinical records or pertinent documents for claims. Moreover, s/he works closely with the medical and other hospital staff for the resolution of problematic charts.  

   Additionally, s/he is expected to be knowledgeable about multiple PhilHealth benefits and claims management process (e.g inpatient benefits, outpatient benefits, Z benefits). S/he must also be competent in maintaining quality customer services towards patients, and patients’ significant others. Furthermore, s/he is entrusted to being capable of organizing patient records as needed with the process as well as maintaining strict confidentiality with handled documents.

  • Receives claims form and countercheck with transmittal list provided / submitted. 
  • Checks for completeness of data and the required supporting documents attached.
  • Processes documents in relation implementing guidelines and procedures pertaining to PhilHealth benefits claims. 
  • Ensure completeness of documentary requirements in the claims applications before forwarding to the next processing stage. 
  • Verify/validate information declared in the database to ensure correctness.
  • Check the number of encoded claims and verify the accuracy of encoded information in the List of Claims Received. 
  • A graduate of any bachelor’s degree.  
  • Possibly with at least three (3) years of relevant work experience in Hospital records management and insurance claims management.
  • Healthcare industry experience is a plus.
  • Knowledgeable with medical terminologies. 
  • Possibly an ICD 10 encoder  
  • Demonstrated understanding of basic corporate office software, including Microsoft Office 365 applications.
  • Good communication skills. Proficiency in the Visayan dialect and/or Tagalog is required; ability to communicate well in English is an advantage. 

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Employment Applicant Consent Form

In compliance with the Data Privacy Act of 2012 (Republic Act No. 10173), Chong Hua Hospital ensures that your personal data will be handled and processed responsibly and securely.

By ticking the box below, I hereby give my consent to Chong Hua Hospital to collect, use, and process my personal data as part of the recruitment and hiring process.

  1. Personal Data Collection
    I, the undersigned, hereby give my consent to Chong Hua Hospital to collect and process my personal data, including but not limited to my name, contact details, employment history, educational background, and other relevant information
    necessary for the recruitment and hiring process.
  2. Purpose of Data Processing
    I understand that the personal data provided will be used solely for the purpose of evaluating my suitability for employment with Chong Hua Hospital, and for any other purposes related to my job application.
  3. Data Storage and Security
    I acknowledge that my personal data will be stored securely and will be retained only for as long as necessary to complete the recruitment process or as required by law.
  4. Data Sharing
    I understand that my personal data may be shared within the organization and with third-party service providers, only for the purpose of recruitment and employment-related activities, in accordance with the Data Privacy Act.
  5. Data Subject Rights
    I am aware that I have the right to access, correct, and request the deletion of my personal data, subject to the applicable provisions of the Data Privacy Act.
  6. Consent Withdrawal
    I understand that I may withdraw my consent at any time by notifying Chong Hua Hospital in writing, and that withdrawal may affect my eligibility for employment.

I have read and agree to the terms outlined above regarding the collection, use, and processing of my personal data.

CONFIDENTIALITY AGREEMENT

It is the responsibility of all Chong Hua Hospital workforce, including employees, medical staff, house staff, interns, fellows contracted medical staff and volunteers, to preserve and protect the confidential patient, employee and business information.

The Constitution of the Republic of the Philippines (Article III Section 3), Civil Code of the Philippines (Article 19, Article 26), Revised Penal Code of the Philippines on revelation of secrets and the rule on doctor-patient confidentiality govern the release of patient identifiable information by hospitals and other health care providers. All of these laws establish protections to preserve the confidentiality of various medical and personal information and specify that such information may not be disclosed except as authorized by law or the patient or individual.

Confidential Patient Care Information includes: Any individually identifiable information regarding a patient’s medical history, mental, or physical condition or treatment, as well as the patient’s records, test results, conversations, research records and financial information. These may include, but are not limited to:

  • Physical medical and psychiatric records including paper, photo, video, diagnostic and therapeutic reports, laboratory and pathology samples;
  • Patient insurance and billing records;
  • Mainframe and department based computerized patient data and alphanumeric radio pager messages;
  • Visual observation of patients receiving medical care or accessing services; and
  • Verbal information provided by or about a patient

I hereby understand and acknowledge that:

  1. I shall respect and maintain the confidentiality of all patient laboratory results, care records and any other information generated in connection with individual patient care, risk management and/or peer review activities;
  2. It is my legal and ethical responsibility to protect the privacy, confidentiality and security of all medical records, proprietary information and other confidential information relating to Chong Hua Hospital and its affiliates, including business, employment and medical information relating to our patients, members, employees and health care providers.
  3. I shall only access or disseminate patient care information in the performance of my assigned duties and where required by or permitted by law, and in a manner which is consistent with officially adopted policies of Chong Hua Hospital only with the express approval of my supervisor or designee. I shall make no voluntary disclosure of any discussion, deliberations, patient care records or any other patient care, peer review or risk management information, except to persons authorized to receive it in the conduct of Chong Hua Hospital’s healthcare affairs.
  4. I agree to discuss confidential information only in the work place and only for job related purposes and to not discuss such information outside of the work place or within hearing of other people who do not have a need to know about the information.
  5. My obligation to safeguard patient confidentiality continues after my termination of deployment with Chong Hua Hospital.

I hereby acknowledge that I have read and understand the foregoing information and that my signature below signifies my agreement to comply with the above terms. In the event of a breach or threatened breach of the Confidentiality Agreement, I acknowledge that Chong Hua Hospital may, as applicable and as it deems appropriate, pursue disciplinary action and/or file the appropriate civil and criminal case against me including the termination of my deployment.

This responsibility of confidentiality shall continue even after the completion of my deployment with Chong Hua Hospital.

I AGREE

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