18/03/2022
WE'RE HIRING!
Caritas Health Shield, Inc. is in need of Member's Care and Hospital Services Assistant (see poster below for details).
DUTIES, FUNCTIONS, AND RESPONSIBILITIES:
• Ensures that the Letter of Authorization (LOA) is submitted to the hospital as soon as possible or within twenty–four (24) hours from the time of admission of the member
• Conducts hospital visits to admitted members everyday even availment is not covered
• Attends to admission and discharge of members as much as possible
• Confers with attending medical doctor, looks at the patient’s chart, talks to the confined member, his relatives, and other hospital staffs taking care of our member to get complete data needed to determine coverability and limitation of hospital benefits
• Informs member’s the extent of his coverage or informs the same if his case is not covered
• Ensures that PhilHealth documents or senior citizen requirements if applicable are properly filled out and submitted before discharge
• Makes sure excess charges/incremental costs are paid by the member before discharge
• Regularly updates the Request for Assistance (RFA) whenever necessary and especially with regard to progress notes (e.g. new diagnostic procedures, non-covered items, co-management, and Member’s Benefit Limit (MBL))
• Coordinates closely with the different outpatient department cost centers such as laboratory, radiology, heart station, dialysis center, oncology center, eye station, stone center, endoscopy unit, etc. to remind their staff about our NO LOA/No approval – No coverage policy. Reminds hospital staff constantly that they should limit the procedure to be performed to our members based on our approval or endorsement in the LOA. Otherwise, we will not be responsible for its payment.
• Continues to monitor ER availments, reminding and coordinating with ER staff that all availments must have approval, otherwise, the member must pay for the cost incurred prior to discharge
EXTERNAL CLIENTS (PROVIDER RELATIONS) FUNCTIONS:
• Accredits hospitals, doctors, dentists, diagnostic centers, and laboratories
• Continually updates the doctors’ schedule of an accredited hospital and informs Head Office of any changes
• Establishes and updates providers’ folder which should contain but not limited to the following:
a. Accreditation contracts
b. Ledger of billings/statements of account and payments made
c. Scanned copies of billings/statements of account, check vouchers, and Official Receipts of payment made
