Hey I am John Dave

HOLY NAME UNIVERSITY MEDICAL CENTER, INC.
(Medical Health Insurance Assistant)

Finalize the list of coordinators and accredited doctors for daily shifts, ensuring coverage for all required services.
Prepare and update schedules of doctors and coordinators, adjusting as necessary to ensure adequate staffing.
Verify the accuracy and completeness of laboratory and medical requests submitted by physicians to ensure they align with the patient's needs.
Review patient’s supporting diagnosis and chief complaints to ensure proper documentation and compliance with HMO protocols.
Ensure all documentation is up to date and in accordance with HMO requirements before proceeding with approvals.
Contact HMO partners and follow up on requests to ensure timely approval for the patient's treatment, procedure, or testing.
Coordinate with the HMO to clarify any queries and provide additional documentation if needed to expedite the approval process.
Once approval is secured, issue the approved OPD/Laboratory forms to the cardholder and guide them through the availment process, ensuring they understand the steps and requirements.
Attach charge slips to approved requests to ensure that all financial details are properly recorded and attached to the patient's file for tracking and reconciliation.
Record all transactions in MS Excel or a relevant database for real-time tracking and future reference.
Ensure that the financial data is consistently updated to facilitate efficient reconciliation and to monitor the status of pending requests.
Submit HMO forms to the cashier for ER posting, ensuring that billing is processed promptly and correctly.
Report complete and accurate patient information to HMO partners after admission for the initial issuance of the Letter of Authorization (LOA).
Follow up with the HMO to ensure that the LOA is issued in a timely manner, avoiding delays in patient treatment.
Update patients and internal departments on any changes or additional documentation needed during the LOA approval process.
Ensure that the Letter of Authorization is correctly linked with the patient's file and that all supporting documents are attached.
Facilitate queries and requests from affiliated companies, including price quotations for laboratory services, and ensure prompt responses.
Endorse all queries for approval by the Finance Officer to ensure alignment with company policies.
Assist affiliated companies with the coordination of their Annual Physical Exams (APEs), notifying all relevant departments of the availment date, tests required, and patient needs.
Ensure that schedules for APEs are well-coordinated with the lab and medical staff to avoid delays or scheduling conflicts.
Monitor the approval timelines and escalate issues where necessary to avoid any delays in patient treatment or hospital processes.
Provide training and guidance to new staff members or junior coordinators to ensure a smooth workflow and consistent adherence to procedures.