DUTIES & RESPONSIBILITIES
• Receives daily bills from MediCard Claims Receiving Clerk. Receiving copy must be returned to MediCard within the day. Files Receiving Summary per hospital/doctor.
• Encodes info to the CPS. Verifies benefits and limitations through MediCard Intranet Solutions. Determines the amount to be paid. Amount and number of patients should tally with the billing from the hospital.
• Make sure that all hospital bills must have LOA or approval number in order to validate approved and disapproved charges. A special accommodation form/letter must be attached for any special arrangement made by the MediCard Medical Operations Department/Customer Management Department with regard to the approval of hospital rates, professional fees and other accommodation extended to our members.
• Print and attach utilization report for all in-patient and dental services. For out-patient consultations and medical services, a utilization report shall be attached to the bills for checking of the pre-existing conditions and dreaded diseases and other illnesses whenever necessary.
• Submits processed bills to MediCard Jr. Supervisor/Assistant Supervisor and Medical Administrator for checking and approval.
• Make sure that all advances/cost + accounts be billed by the MediCard Billing Clerk. All disapproved charges/accommodations extended to our employees and agents must have a corresponding Debit Memo (DM).
• Effect corrections, if any, and print final HBA, Summary of OP, DT and Med. Services. Forward processed/approved bills to MediCard A/P Clerk for check preparation.
• Submits Daily Processed Report and Weekly Status Report to Claims Jr. Supervisor/Assistant Supervisor.
• Maintains file for Daily Processed Report/Receiving Summary, Action Memos, Incident Reports, Logbooks and other pertinent documents.
• Makes sure that all bills received be processed within 5 days and be paid on or before their due dates.
• Attends to all inquiries of medical providers (hospitals and doctors) regarding unpaid bills.
• Delivers check payments to the assigned medical providers if necessary.
• Performs other related tasks that may be assigned from time to time.