Ave Gail
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Province of Davao del Sur, Philippines
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- CMedical BillerCS Modern Workforce (WFH)Nov 2023 - May 2026 (2 years 7 months)• Insurance follow-up via call and portal utilization • Eligibility and benefits verification • Payment posting (manual & electronic) • Claim denial and Rejection management • Designated to work on high-dollar accounts • Claim submission (both electronic and paper) • Medical records submission.
- FAccounts Receivable RepresentativeFocusinc Group Corp. (BPO)Apr 2022 - Oct 2023 (1 year 7 months)• Review denials on an explanation of benefits (EOB) statement and work on issues until resolved by calling insurance companies or utilizing provider portals. • Resolve inappropriate payments with insurance carriers that are not in compliance with payer contract rates by calling insurance companies to have the claim reprocessed or drafting and submitting "low pay" appeal via fax or mail. • Drafts and sends out appeals (mail or fax) for claims that were denied for timely filing, non-medically necessary, low payment & no authorization. • Submit medical records or clinical documents via mail or fax as needed by the insurance company to expedite payment of insurance claims. • Analyze A/R (Accounts Receivable) reports to follow up on unpaid high
- SMedical Billing SpecialistSix Eleven Global Teleservices (BPO)Apr 2019 - Mar 2022 (3 years)• Analyze A/R (Accounts Receivable) reports to follow up on unpaid claims by calling insurance companies or utilizing provider portals. • Submit medical records or clinical documents via fax and mail as needed by the insurance company to expedite payment of insurance claims. • Review denials on an explanation of benefits (EOB) statement and work on issues by calling insurance companies or utilizing provider portals for a resolution. • Performs minor demographic update in billing software. • Ensures payments received via 835 remittance and EOBs received via mail are applied to the patient's account in a timely manner. • Leveraged medical appointment scheduling skills to ensure accurate patient demographic information was on file, which strea