Rouella Gado

Present

· Position: PhilHealth Staff

· Name of Office/Unit: Finance and Accounting Department

· Immediate Supervisor: Mr. Humo-Bono A. Ravanes

· Name of Agency/Organization and Location: The Hospital At Maayo, UN Avenue Corner DM Cortes, Mandaue City, Cebu

· List of Accomplishments and Contributions

o PhilHealth has issued Circulars, notably PC2025-0006 and PC2025-0019, providing an "amnesty" or "flexibility" program for hospitals to reprocess claims denied from Jan 1, 2018, to Dec 31, 2024, primarily due to late filing. This allows facilities to re-file these claims within a six-month window (starting early 2025) with complete requirements, even those previously unprotested or in court, to get paid for services rendered, acknowledging systemic issues with electronic filing deadlines. I am the one handling this flexibility. After complying, I received payment from PhilHealth within 7 months; out of the P50 million total, P40 million has already been paid.

· Summary of Actual Duties

1) Transmitted/processed monthly hemodialysis Philhealth Benefit Claims of patients in accordance with Philhealth policies

and procedures.

2) Processed OECB package Outpatient Emergency Care Benefit it started June 25, 2025.

3) Prepared Mandatory Monthly Hospital Report in a timely manner within prescribed period every 10th day of the month.

4) Submitted Quarterly Report of Unsubmitted Claims and Summary of Unpaid Claims - Account Receivable to PHIC

regional office (oplan reconciliation).

5) Refiled denied claims due to late submission from January 1, 2018, to December 31, 2024. This circular offers a 6-month

window from its effectivity date for re-filing with complete requirements.

6) Attended to any other matters pertaining to Philhealth as need arise. Refiled return to hospital claims specifically

hemodialysis. Assisted denied claims.

7) Assigned ICD10 coding for discharge of the day inpatient

8) Coordinated with our third party Philhealth provider STASH as needed.

• Responsible for the preparation, audit and submission of PhilHealth, PCSO, DSWD and any other streams guarantee letter available in Diacare Dialysis Center
• Monitored and recorded daily cash flow treatment records and daily sales
• Maintained records of each patient and their respective treatment along with the transmittal conducted
• Monitored monthly record census, supplies and monthly income, expenses and other statement of accounts
• Assisted on any BIR filings along with any government mandated dues
• Reported all assigned works to management through email, messenger or any company organized communication platform
• Coordinated with management with any updates, changes or alteration in any administrative works but not limited to PhilHealth, Bizbox, PCSO, DSWD, Province Medical Assistance and other financial assistance the company and its patient availment
• Reported any and all updates, letter, notice and denied claims, RTH to administrative office
• Maintained records of all the transmittal and guarantee letters pertinent to our operation

• Answered all inquiries about Philhealth
• Interviewed and received Philhealth paper from patient/member
• Checked if all necessary PHIC documents are complete and in order
• Processed and computed allowable availment for both in and out patient for discharge
• Encoded all out-patients' data to the computer for computer generated claim form two
• Prepared PHIC monthly mandatory reports
• Processed all necessary requirement for yearly PHIC accreditation
• Attended to any other matters pertaining to PHIC as need arise

• Admitted patients to room of choice
• Notified nurses' station of incoming admission
• Explained hospital policies to patient relative or accompanying who will fill up patient's data sheet at the admitting counter
• In charged of keeping the information sheet/patients' data; recorded it at the census notebook, census clipboard and making admission envelope with the specific details written on it
• Attached clinical case date of patients in the chart
• In charged of answering internal and external calls for a minimum of three rings only
• Responsible to all endorsement relayed verbally and in written order and record it at the endorsement notebook
• Makes patients chart and must see to it that all needed forms and supplies are available
• Did the cashiering after business office of 5:00 p.m. and must be responsible in keeping the collection sales in safe manner
• Take good care of the equipment and supplies in the department
• Given inquiries and directing patients/clients correctly, asking for doctor's clinic schedule and patient's room
• Friendly, accommodating, approachable and courteous from line staff of the department
• In charged of giving out complete and accurate data stated at the pin card
• Advised patient to ask for a charge ticket to the department concern and after which proceed for payment during office hours and back to the information counter to claim the printed pin card
• After office hours patients will present the pin slip at the information staff to assign pin number and pay to the pin cashier at the information counter
• Advised patients properly in presenting the pin card to the department concern
• For outpatient care of HMO and insurance pink form is issued with the permanent pin number to the concern department, once its cleared
• If patient with the previous record as outpatient, it is the responsibility of the pin in charge to press the control F key to search if patients had a previous record
• For inpatient that had previous record of pin number, the details stated therein will be copied to the recent date of his/her admission to date
• Acted as directory assistance for physicians, patients, visitors and hospitals personnel
• Channelled all calls that is incoming to different department or persons concerned
• Supervised all calls and sees the hospital telephone are used for official business
• Paged for needed personnel especially during emergencies
• In charged of keeping the voice in good intonation in a friendly manner
• Observed the proper telephone etiquette
• Performed other work-related functions which may be assigned by the immediate supervisor

• In charged of the proposals to win a new contract
• Assisted in the preparations of bidding documents, quotations, orders and request
• Attended bidding in some location as representative

• Assisted customers by providing product recommendations, answering questions, alerting customers to production options; responded to customers complaints politely in appropriate manner
• Reviewed order before and after delivery to ensure that the orders are complete, charges are correct and the customer is satisfied
• Expanded sales revenues by up-selling support programs and products accessories in sending documents, parcels, packages and money, processing bills payments
• Developed solutions for customers by listening to their needs and recommending the appropriate products
• Provided great and excellent customer service
• Promoted products to customers by product demonstrating and sampling
• Reported daily and monthly sales and inventory to team head
• In charged in giving funds in six branches used for remittance
• Processed bills payment
• Processed send and received Kwarta Padala remittance
• Processed received and send packages, parcels and documents

• Fill out Philhealth CF4 and CF3 of the patient
• Encoded discharged patient
• Encoded medicines request
• Encoded procedures of the patient
• Processed request of the patient like medical certificate, photocopy of all laboratory and procedure results in the medical record
• Monitored O2 tank charges of the patient