MediCard Phils., Inc. is one of the country's leading HMO and the only HMO founded and run by Doctors. Since its inception, the concept of service-oriented total health care has been the molding ideal of MediCard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality.
MediCard now boasts of more than half a million members and over 54,000 accredited doctors in over 1,000 hospitals and clinics nationwide. It also operates 16 MediCard free-standing clinics that provide services at par with those offered by hospitals minus the confinement. MediCard is currently looking for assertive, dynamic and energetic individuals to fill up the following vacancy: The MediCard Liaison Officer (LO) serves as a Care Partner and Member Advocate, ensuring that members receive timely, medically appropriate, cost-effective, and seamless services within the healthcare ecosystem.
The LO acts as the face of MediCard within healthcare facilities, guiding members through their healthcare journey, facilitating benefit utilization, coordinating with healthcare providers, and promoting quality healthcare outcomes while ensuring compliance with MediCard policies, medical necessity standards, and utilization management principles. The role extends beyond traditional benefit administration by delivering an exceptional member experience that aligns with MediCard's mission of making healthcare accessible, affordable, predictable and easy to navigate for Filipinos.
DUTIES & RESPONSIBILITIES 1. Healthcare Navigation · Serve as the primary point of contact for members within assigned healthcare facilities. · Guide members in accessing appropriate healthcare services and providers. · Assist members in understanding healthcare benefits, limitations, and available options. · Provide support throughout admission, confinement, treatment, and discharge processes.
· Facilitate referrals and coordination of care as needed. · Assist members in navigating complex healthcare situations. Success Indicators · High member satisfaction ratings · Improved healthcare navigation experience · Reduced member confusion and escalations 2. Benefit Implementation and Management · Verify member eligibility and benefit coverage. · Facilitate timely processing of approvals and authorizations.
· Explains the coverage, limitations and exclusions, as well as requirements. · Ensure services rendered are within approved benefits and coverage guidelines. · Support efficient claims and documentation processes. Success Indicators · Compliance with authorization turnaround times · Reduced benefit-related complaints · Accurate benefit application 3. Medical Appropriateness and Care Coordination · Facilitate implementation of MediCard utilization management policies.
· Coordinate with healthcare providers regarding covered healthcare services. · Support medically necessary and evidence-based healthcare practices. · Promote treatment in the most appropriate level of care. · Escalate complex medical necessity concerns to designated clinical teams. Success Indicators · Appropriate utilization of healthcare resources · Reduced unnecessary admissions and procedures · Positive provider collaboration 4.
Member Experience Excellence · Deliver compassionate and professional member support. · Practice active listening and empathy during member interactions. · Manage concerns and complaints promptly. · Conduct service recovery activities when necessary. · Ensure every member interaction reflects MediCard's brand promise. Success Indicators · Member Satisfaction Score targets achieved · Increased Net Promoter Score (NPS