Medical Billing | A/R Specialist | Insurance Verification
Cavite
I am a Healthcare Revenue Cycle and Medical Billing Specialist with nearly three years of experience supporting U.S. healthcare providers. My expertise includes accounts receivable (A/R) follow-up, insurance billing, denial management, claims resolution, insurance eligibility and benefits verification, pre-billing audits, and reimbursement optimization. I have worked with Commercial, Medicare, Medicaid, and VA insurance plans, reviewing EOBs, resolving denied and rejected claims, correcting billing errors, verifying coverage, and following up with insurance companies to secure timely reimbursement. I also collaborated with coding and credentialing teams to resolve claim issues and improve payment outcomes. Most recently, I worked as an Audit Specialist for Home Health Care providers, performing pre-billing audits, verifying patient eligibility and prior authorizations, reviewing documentation for billing accuracy, and processing claims through ClaimMD. Previously, I managed over 56 claims daily as an A/R Claims Specialist using EPIC PB, Waystar, and multiple payer portals. I am proficient in EPIC PB, Paradigm, WellSky, AxisCare, Alora Health, Waystar, ClaimMD, and major payer portals. I am detail-oriented, adaptable, and committed to delivering accurate, efficient, HIPAA-compliant work while providing excellent support to healthcare providers and patients.
Paradigm Seniors, full_time
Jan 2026 to Jul 2026
• Performed pre-billing audits for Home Health Care claims across the Southern Region (Ohio, Indiana, Illinois, Pennsylvania, Tennessee, Michigan, and Wisconsin) for Medicaid and VA patients. • Ensured accurate claim submission by reviewing and correcting HCPCS codes, resolving service time overlaps, and verifying valid prior authorizations before billing. • Accessed EMR systems, including ClearCare/WellSky, AxisCare, and Alora Health, to obtain and validate authorization information. • Utilized ClaimMD and various insurance payer portals to verify patient eligibility, check claim status, and review denial and rejection reasons. • Conducted accounts receivable follow-up, investigated partially paid and denied claims, and collaborated with multiple departments to support efficient daily revenue cycle operations.
Access Healthcare, full_time
Jan 2025 to Jan 2026
• Managed high-volume medical claims (back-end RCM) using EPIC PB, Waystar, and provider portals by correcting billing errors, resubmitting claims, and handling denials and appeals. • Reviewed Explanation of Benefits (EOBs) for payment accuracy and verified patient eligibility and benefits. • Collaborated with billing and coding teams while ensuring HIPAA compliance and improving claim resolution rates.
Optum Global Solutions, full_time
Oct 2024 to Dec 2025
• Handled customer inquiries regarding healthcare insurance plans, coverage, and claims via phone. • Verified eligibility, explained benefits, and resolved claims issues in coordination with internal teams. • Ensured compliance with company policies and HIPAA regulations.