US/PH Registered Nurse | Healthcare Coordinator Claims Specialist
Cavite
I am a versatile healthcare professional with a dual background as a Registered Nurse and a Customer Care Executive, offering a unique blend of clinical expertise and administrative proficiency. My experience spans across direct patient care in intensive cardiovascular units, home healthcare coordination in the United States, and complex insurance operations including medical claims processing and provider credentialing. With an active Philippine Nursing license and having passed the Florida NCLEX, I possess a strong foundation in medical terminology, patient assessment, and care planning. I am adept at navigating the intersection of clinical care and healthcare administration, ensuring regulatory compliance while maintaining a high standard of patient and family support.
AMAZING ANGELS, full_time
Mar 2024 to Apr 2026
Coordinate and schedule home healthcare services for patients Communicate with physicians, nurses, and caregivers regarding care plans Handle patient inquiries and provide support to families Maintain accurate documentation and electronic health records (EHR) Assist with insurance verification and authorization processes Manage staff schedules and assignments
University of Perpetual Help System DALTA, full_time
Jun 2022 to Jun 2024
Educate and counsel patients on cardiovascular diseases and prevention. Assist in diagnosing and treating heart-related conditions. Perform and interpret cardiovascular tests (e.g., ECGs, labs). Monitor patients, vitals, and cardiac devices like pacemakers. Communicate with patients and families before and after treatment.
BANKER'S LIFE HELATH INSURANCE COMPANY, full_time
Jul 2018 to Mar 2022
Review and process medical or insurance claims for accuracy and completeness Verify patient information, coverage, and eligibility Ensure claims comply with insurance policies and regulatory requirements Identify and resolve claim discrepancies or denials Coordinate with healthcare providers, insurance companies, and internal teams Maintain accurate records and documentation in claims systems Meet productivity and quality target Assist with claim appeals and resubmissions when necessary
Conduent Philippines, full_time
Apr 2014 to Jul 2018
Collect, verify, and maintain provider credentials (licenses, certifications, education, work history) Process initial credentialing and re-credentialing applications Coordinate with insurance companies and regulatory bodies for provider enrollment Monitor expiration dates and ensure timely renewals Maintain accurate records in credentialing databases and systems Ensure compliance with healthcare standards and accreditation requirements Communicate with providers regarding missing or incomplete documents Assist with audits and resolve credentialing discrepancies