5. MEMBER RELATIONS ASSISTANT
CARITAS HEALTH SHIELD
Quezon City, PH
5d ago

Job RequirementsGraduate of BS in Nursing, Physical Therapy, or any medical-allied courses Preferably with PRC License Excellent interpersonal relation skills and can relate with all levels of people Computer literate Has a good eye for detailsGeneral Job Description Accomplishes Request for Assistance (RFA) for walk-in and phone-in requests : a.

Verifies membership status b. Checks Summary of Payments (SOP) and payment status c. Determines nature of requests (e.g.

consultation, outpatient diagnostic procedure, therapeutic procedure, emergency care, or elective admission) d. Determines which health care provider the member will avail his benefit with e.

Checks Waiver of Coverage (WOC) and medical declarations. Reports significant information to proper authorities (concealment) f.

Makes sure all information required to satisfy the RANC / CHAMFIT is included in the RFA Submit duly accomplished RFA for approval of the Member Benefits Supervisor / Medical Manager Prepares the necessary Caritas Medical accountable form needed if the request is covered (consultation form, special referral form, laboratory request form, or Letter of Authorization) for approval of the Medical Benefits Supervisor / Medical Manager Ensures that the online record of Member’s RFA is duly accomplished : a.

Ensures member affixes his signature on the appropriate space (s) b. Ensures all information needed is indicated in the form Monitors and collects member’s excess charges billed after discharge Receives and sends out a statement of account for member’s excess charges, if any Receives reimbursement documents and ensures that required attachments are complete and original before transmitting to reimbursement section, head office Receives Board of Appeals and Review cases and ensures that required attachments are complete before transmitting to head office OTHERS : Maintains the strictest confidentiality and patient’s privacy Performs other tasks and duties that may be assigned by immediate superior from time to time

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