[ref. p51661201] HMO Staff

JOB SUMMARY

Contributes to the delivery of Quality Patient Care and Safety for HMO Members consistent with Metro North Medical Center and Hospital vision, mission and values and the organization’s strategic objectives, to educate customers and enhance the image of the hospital by accurately and professionally ensuring customer satisfaction in a variety of situations with the end result of:

a.) Achieving the desired Average Daily Census (ADC)

b.) Turning HMO members availing in the hospital into advocates of Metro North Medical Center and Hospital

c.) Increasing HMO providers’ customer retention and new business acquisition

• Maintains and adheres to policies on strict confidentiality of all files and records.
• Updates and maintains the records of the different HMO’s such as list of accredited doctors, contact numbers (24/7 call center nos.), contact person/officers, brochures and forms to hasten the process of the availment of the different HMO members.
• Updates and maintains the availment records (daily log in sheet, admission monitoring forms and reports) of HMO members assisted.
• Assists the HMO members in the screening of their availment eligibility in the hospital.
• Educates the HMO members of the availment procedures in the hospital.
• Refers the HMO members to the available accredited doctor for out-patient consultation and in-patient availment with the end result of promoting accredited doctors of HMO’s affiliated in the hospital.
• Adheres to the department’s standard operating procedures in assisting HMO members and facilitating concerns.
• Stores and retains all types of relevant company records (performance, feedback), as well as information collected through the interphase with HMO members.
• Records and compiles gathers information from the interphase with the HMO members.
• Attends to the incoming phone calls and inquiries courteously and accurately within his/her responsibilities or refers them to concerned parties to ensure accurate and proper dissemination of information.
• Systematically acquires and records information from gathered data.
• Coordinates with the HMO providers the extent of coverage of the HMO members.
• Reviews the benefits and coverage applied to the HMO members by the HMO providers.
• Participates actively in the preparation and implementation of customer service programs and services.
• Promotes awareness about the services and facilities available in the hospital.

KNOWLEDGE AND SKILLS

Education:

• Must be a college graduate of any medical / computer science field; health science courses is an advantage.

Work Experience:

• With or without experience in hospital / clinic affiliations as part of entry level preparation; willing to be trained.

Skills:

• With good oral communication and interpersonal skills.
• Ability to work well with others.
• Computer literate (MS Word, MS Excel).