Medical Claims Specialist

Medical Claims Specialist

职位类别： 支持小组
工作类型： 全职
工作地点： 宿务市
Job Summary

在菲律宾首屈一指的医疗保健中心崇华医院，发挥影响力，提升您的职业生涯！

崇华医院正在招聘一位经验丰富、积极主动的 Medical Claims Specialist is mainly responsible for reviewing and analyzing referred charts of discharged patients that may acquire attention and technical in nature. S/he also assesses any denied claims caused by inconsistent data and non-compliance with standard of care. S/he determines whether the denied claims are for appeal, thus, prepares an appeal letter. Moreover, s/he prepares preliminary assessment of patient’s chart pertaining to PhilHealth Insurance Corporation request for a verified letter.  

S/he closely coordinates with the Medical Team for resolution of problematic charts. S/he serves as a medical representative that supports and provides clarification to the Philhealth and Quality Records team in relation to reading charts and verifying claims. One of her/his essential roles is to train the Consultant and Resident Doctors on PhilHealth concepts and rules. S/he is also expected to assist in planning and executing claims improvement initiatives and submit timely and accurate reports of medical claims. 

  • Review medical claims to ensure company reimbursement payments are accurate and reprice claims according to hospital payment schedules and reimbursements. 
  • Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable. 
  • Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims. 
  • Maintains updated records and prepares required documentation to support the insurance claims. 
  • Provide excellent customer service when working with customers and hospitals to resolve insurance claim issues, answer questions, and provide solutions to other problems related to medical claims. 
  • Responsible for creating timely and accurate reports on medical claims and appeals. 
  • May be assigned in a project that aims to improve specific areas, working independently or with a cross-functional team. May be tasked to make necessary recommendations on performance of team members or cross-functional team member.  
  • A graduate of any bachelor’s degree,   
  • A minimum of five to seven (5-7) years of relevant work experience in medical field and with background in claims management 
  • Healthcare industry experience is a plus.  
  • Comprehensive knowledge of insurance plans, member eligibility, and medical billing 
  • Strong background in government and commercial payers 
  • Understands medical terminologies 
  • 证明对基本企业办公软件（包括 Microsoft Office 365 应用程序）的了解。  
  • Excellent communication skills. Proficiency in the Visayan dialect and/or Tagalog is required. 

申请此职位

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求职者同意书

遵照 2012 年数据隐私法（共和国法案第 10173 号），崇华医院确保您的个人数据将得到负责任且安全的处理。

通过勾选下面的方框，我特此同意崇华医院在招聘和雇用过程中收集、使用和处理我的个人数据。

  1. 个人资料收集
    本人，以下签名人，特此同意崇华医院收集和处理本人的个人资料，包括但不限于本人的姓名、联系方式、工作经历、教育背景及其他相关信息。
    招聘和雇用过程所必需的。
  2. 数据处理的目的
    我明白所提供的个人资料将仅用于评估我是否适合在崇华医院就业，以及与我的工作申请有关的任何其他目的。
  3. 数据存储和安全
    我承认我的个人数据将被安全存储，并且仅在完成招聘流程所需的时间内或法律要求的时间内保留。
  4. 数据共享
    我理解，根据《数据隐私法》，我的个人数据可能会在组织内部以及与第三方服务提供商共享，仅用于招聘和就业相关活动。
  5. 数据主体权利
    我知道我有权访问、更正和请求删除我的个人数据，但须遵守《数据隐私法》的适用规定。
  6. 撤回同意
    我明白我可以随时通过书面通知崇华医院撤回我的同意，并且撤回可能会影响我的就业资格。

我已阅读并同意上述有关收集、使用和处理我的个人数据的条款。

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.

我同意

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我同意