HMO Officer at Chion Family Medical Centre

We are currently seeking an experienced and detail-oriented HMO Officer to join our administrative team. The ideal candidate will manage relationships with Health Maintenance Organizations (HMOs) and ensure smooth communication between the hospital, patients, and insurance providers.

Key Responsibilities:

• Liaison Role: Serve as the primary contact for HMOs, handling all queries and correspondence related to healthcare plans, pre-authorizations, and claims.
• Claims Management: Oversee the submission, tracking, and approval of medical claims from HMO patients, ensuring accurate and timely processing.
• Benefit Verification: Confirm patient eligibility and benefits with various HMOs before treatments or procedures.
• Compliance: Ensure all transactions and communications with HMOs comply with regulatory requirements and hospital policies.
• Dispute Resolution: Address any discrepancies or issues with claims or coverage between patients and HMOs.
• Record Keeping: Maintain accurate and up-to-date records of all HMO-related transactions and interactions.
• Billing Coordination: Collaborate with the billing department to resolve discrepancies in billing and payments related to HMO patients.
• Relationship Management: Build and maintain strong relationships with HMO providers to ensure excellent service delivery and effective communication.

Qualifications:

• Education: Bachelor\'s degree in healthcare administration, business administration, or a related field.
• Experience: Minimum of 2-3 years of experience in an HMO officer or healthcare administrative role, preferably in a hospital setting.
• Knowledge: Strong understanding of health insurance processes, claims management, and HMO operations.

Skills: 

•  Excellent communication and interpersonal skills.
•  Strong attention to detail and organizational abilities.
•  Ability to multitask and work under pressure in a fast-paced environment.
•  Proficiency in healthcare management software and MS Office.

Benefits:

• Comprehensive health and wellness benefits.
• Opportunities for professional growth and development.
• Supportive work environment with a focus on work-life balanc