Philhealth Associate
Job Description
De Los Santos Medical Center is looking for a highly organized and detail-oriented PhilHealth Associate to support the efficient processing of PhilHealth transactions and claims. The successful candidate will play a key role in ensuring accurate documentation, patient eligibility verification, claims management, and compliance with PhilHealth policies while delivering excellent service to patients and stakeholders.
Key Responsibilities
Documentation & Patient Assistance
Assist patients in understanding and complying with PhilHealth requirements, policies, and procedures.
Review, validate, and organize PhilHealth documents to ensure completeness, accuracy, and timely processing.
Verify physician accreditation and ensure all supporting documentation meets PhilHealth standards.
Provide guidance to patients regarding benefit eligibility, claim requirements, and submission processes.
Claims Processing & Account Management
Assess patient eligibility for PhilHealth benefits and applicable deductions.
Process PhilHealth claims accurately and efficiently in accordance with established guidelines and regulations.
Monitor and follow up on incomplete requirements to facilitate timely claim submission and approval.
Investigate and resolve denied, returned, or disputed claims, including the preparation of appeal letters and supporting documents.
Prepare and submit required reports while maintaining accurate records of all transactions.
Ensure timely, compliant, and error-free claims processing to support hospital revenue cycle operations.
Compliance & Quality Assurance
Maintain compliance with PhilHealth regulations, hospital policies, and government healthcare standards.
Collaborate with medical, billing, admissions, and finance teams to ensure seamless claims management.
Contribute to process improvements that enhance operational efficiency, service quality, and patient satisfaction.
Qualifications
Bachelor’s Degree in any relevant field.
DOH ICD-10 Training Certificate is required.
Experience in PhilHealth claims processing, hospital billing, healthcare administration, or related functions is an advantage.
Strong understanding of PhilHealth policies, healthcare documentation, and claims procedures.
Excellent attention to detail, analytical thinking, and problem-solving skills.
Proficient in Microsoft Office applications and healthcare information systems.
Strong communication and interpersonal skills with a customer-focused approach.
Ability to manage multiple tasks effectively in a fast-paced healthcare environment.
Why Join De Los Santos Medical Center?
Join one of the Philippines’ trusted healthcare institutions and be part of a dedicated team committed to delivering exceptional patient care, operational excellence, and healthcare accessibility for the community.
