Medical Biller | AR Specialist | Insurance & Claims Expert | LTC & Skilled Nursi

Customer Service Representative / Subject Matter Expert Teleperfomance Philippines - Davao City September 2019 to July 2024 * Provide clear, accurate explanations of health insurance benefits, claims, deductibles, copays, and coverage options to members. *Delivered high-quality customer service while handling sensitive healthcare and insurance inquiries with empathy and professionalism. *Resolved customer issues efficiently by researching accounts, claims, and eligibility using insurance systems and databases. *Maintained compliance with HIPAA and company privacy policies when handling confidential member information De-escalated frustrated or emotional callers by actively listening and offering effective solutions. *Collaborated with internal teams (claims, providers, supervisors) to resolve complex cases. *Managed high call volumes while meeting performance metrics such as call quality, resolution time, and customer satisfaction.

Account Receivable Specialist/ Medical biller Comprehensive A/R Solutions - Davao City July 2024 to Present *Detail-oriented Medical Biller with experience in Skilled Nursing Facility (SNF) billing, specializing in MLTC Medicaid, Medicare HMO and Commercial insurance claims. Managed primary and secondary claims submission via certified mail, clearing house, fax & email. *Results-driven Claims Specialist with experience in Skilled Nursing Facility Stay, seeking to leverage expertise in claims processing, denial management, and multi-state insurance regulations across Ohio, New York, Tennessee, New Jersey, Pennsylvania, Kentucky, Iowa, and Nebraska to ensure accurate and timely reimbursement. *Prepared and submitted medical claims for Ancillary rehabilitation services (Physical therapy, Occupational therapy, Speech therapy, Telemedicine, Flu vaccine, Transportation). *Monitored and followed up on aged Part A and Part B claims to guarantee timely reimbursement by investigating through insurance portal, calling insurance or sending an email inquiry.

Account Receivable Specialist/ Medical biller Comprehensive A/R Solutions - Davao City July 2024 to Present *Detail-oriented Medical Biller with experience in Skilled Nursing Facility (SNF) billing, specializing in MLTC Medicaid, Medicare HMO and Commercial insurance claims. Managed primary and secondary claims submission via certified mail, clearing house, fax & email. *Results-driven Claims Specialist with experience in Skilled Nursing Facility Stay, seeking to leverage expertise in claims processing, denial management, and multi-state insurance regulations across Ohio, New York, Tennessee, New Jersey, Pennsylvania, Kentucky, Iowa, and Nebraska to ensure accurate and timely reimbursement. *Prepared and submitted medical claims for Ancillary rehabilitation services (Physical therapy, Occupational therapy, Speech therapy, Telemedicine, Flu vaccine, Transportation). *Monitored and followed up on aged Part A and Part B claims to guarantee timely reimbursement by investigating through insurance portal, calling insurance or sending an email inquiry.