HMO Staff

Key Responsibilities:

• Verify HMO card validity and patient eligibility for consultation, procedures, or hospitalization.
• Coordinate directly with HMO providers via phone, email, or online portals to obtain required approvals or LOAs (Letters of Authorization).
• Accurately encode patient and HMO details into the hospital or clinic system.
• Ensure that all necessary documents (e.g., doctor's orders, request forms) are submitted to the HMO for approval.
• Follow up pending approvals and escalate issues for urgent cases when needed.
• Inform patients and internal departments (e.g., admitting, nursing, billing) of approval statuses or benefit limitations.
• Maintain organized records of all HMO transactions and authorizations.
• Assist in updating HMO provider contact information and policy guidelines.
• Provide customer service to patients regarding HMO-related questions and procedures.
• Comply with hospital...