Job Description
Job Purpose / Objective:
Extract the data from HMG VIDA system and reconcile with insurance company data to ensure reliable financial reports
Key Responsibilities / Accountabilities :
- Create New Company (Regular and Insurance) files in the System according to agreed-upon discount terms and condition.
- Prepare and process all companies (Regular and Insurance) policies for entering in the system after obtaining required administrative and management approvals.
- Receive and process modifications, renewals, and cancellation for all companies (Regular and Insurance) for updating in the system.
- Provide referral office with all information sheets prepared for company and insurance company creation and /or modification.
- Provide information and update Patient Services and Nursing Department about summary of all new, updated, and/or modified company and insurance company information after entering in the system.
- Prepare and distribute Ready Reference Table for all companies (Regular and Insurance) policies including the following; to all reception areas and clinics.
- Services covered or No Covered
- Inclusions and exclusions
- Checklist for all new, updated and modified policies
- Review and ensure the correctness and accuracy of all companies (Regular and Insurance) data while entering in the system or already entered in the system.
- Process and enter all companies (Regular and Insurance) policies and information in to S.D Pharmacy system.
- Prepare Ready Reference Table for S.D pharmacy for all companies (Regular and Insurance) polices including Medicines and services covered or not covered, basin information, inclusions and exclusions and checklist information requested by the Pharmacists to know at the time of billing invoices.
- Receive and maintain master file for all documents received related to company and insurance company policies, renewals, modification, cancellation, correspondence, etc.
- Maintain balancing and logging procedures of any company and insurance company of creations, modifications, and/or deletions to provide proper accounting and management controls.
- Modify procedures codes as requested by Patient Services and/or Physicians after verification of company and insurance company policy terms in relation to diagnosis, covered and/or non-covered, preexisting and/or company approval based on physician’s opinion and reverses modification after invoice is processed.
- Process outward referrals to outside providers when Referral staff is not available.
- Participate in person-centered care initiatives undertaken by HMG.
- Enrich patient experience with compassion, respect and dignity.
- Perform other applicable tasks and duties assigned within the realm of his/her knowledge, skills and abilities
Job Specifications:
Education/ Professional Qualification
- Bachelor’s Degree
- Healthcare related
Experience
- At least (3) years data entry experience.
- At least (1) year with health care organization in billing or insurance related field.
Professional Licensing / Certification / Training
