Billing Specialist, PhilHealth (Philippines)

We are excited to announce that a position of Billing Specialist (PhilHealth) is currently open. This is a crucial role in ensuring the efficient processing and management of PhilHealth claims, contributing significantly to our operational success.

If you are detail-oriented, proactive, and have a passion for healthcare administration, we encourage you to apply for this role. This is an opportunity to advance your career and make a meaningful impact within our organization.

Key functions:

1. Establish and maintain a billing schedule to ensure all unbilled PhilHealth transactions for each assigned center are covered.

• Secure the billing schedule to cover unbilled PhilHealth transactions for each assigned center.
• Coordinate with the center’s Administrative Assistant to determine billing and documentation policies, ensuring compliance.
• Check the accuracy of patients’ PhilHealth information.
• Monitor the billing timeline and upload properly scanned claim documents to the SharePoint folder.
• Validate each document and request re-uploading if necessary.
  
  

2. Prepare and process claims daily.

• Accurately log eClaims credentials for each assigned center.
• Process an average of 30 claim submissions per day.
• Verify data input in the eClaims system to ensure the accuracy of final transmissions.
  
  

3. Conduct simple analytics on deficient claims and establish countermeasures to prevent recurrence.

• Review claim statuses weekly.
• Compile and conduct root cause analysis of Return to Hospital (RTH) claims to identify appropriate remedial actions.
• Follow up on in-process, refiled, and appealed claims with the respective PhilHealth Regional Offices.
  
  

Qualifications:

• Candidate must possess at least a Bachelor's/College Degree
• Preferably with at least one (1) year experience as PhilHealth billing clerk or similar role
• Familiarity with PhilHealth claim documentation standards.
• in-depth knowledge of the eClaims system
• Intermediate in using Office 365 applications (MS Teams, MS Excel and PowerPoint).
• Highly organized with strong attention to detail.