Medical Biller | SNF Case Manager | Medical Admin
Rizal
6 years of solid experience in the healthcare industry. Highlighting my background with the patient's eligibility, benefits, claims, authorizations, referrals, and appeals. I also have experience with the claim scrubbing, quality analyst, trainer, case manager in an SNF, medical biller for ABA and Woundcare TeleHealth Providers.
MEDVA, full_time
Mar 2025 to Sep 2026
Submitting claims, doing claims follow-ups, reviewing and investigating rejected and denied claims, and resubmitting the corrected claims for the telehealth wound care provider and ABA providers For mental health, do HR onboarding and I-9 verification with the newly hired wound care. Providers and Wound Care Technicians. Providing navigation training to the newly hired wound Care providers and wound care technicians with the tools and HER/EMR needed to utilize in a daily basis. Sending daily, weekly, and monthly wound and debridement reports to both the providers and the facilities. Deals with order processing with the providers’ medical supplies they use for wound care, such as the gauze, wound cleanser, and debridement instruments.
ISTA SOLUTIONS, full_time
Aug 2023 to Mar 2025
Deliver training and instruction to engage and stimulate existing and newly hired employees in a manner that promotes the transfer of knowledge and application of skills. Plan and prepare instructions, exercises, and independent assessments to promote retention. through the effective use of questioning, presentation, and facilitation skills and providing feedback and coaching that enhances performance.
ISTA SOLUTIONS, full_time
Dec 2022 to Jul 2023
Sending clinicals for authorization extension of the patients on behalf of the facilities, do UR meeting once a week to discuss the patients’ condition, answers emails, and calls and faxes to assist facilities and insurances with their concern regarding the authorizations, high-cost medication requests, and appeals.
ISTA SOLUTIONS, full_time
Jun 2022 to Nov 2022
Covering for the sub-acute case managers once they are absent/on leave, training, and evaluating newly hired, assisting team members and/or case leads (before known as Team Leader) with their daily tasks.
GEBBS HEALTHCARE SOLUTIONS, full_time
Aug 2021 to Jun 2022
Facilitates client calibrations, coaching agents, and worked on client complaint analysis. Evaluating Agents' Performance, Daily/Weekly/Monthly Reports for Onshore Quality Team
GEBBS HEALTHCARE SOLUTIONS, full_time
Jun 2021 to Aug 2021
Handled inbound calls for a healthcare account, answered and assisted callers/members with regards the non-emergent medical transportation.
ALORICA TELESERVICES INC., full_time
Jan 2020 to Jun 2021
Handled inbound calls for a healthcare account, answered and assisted callers (providers) with inquiries regarding the policies, eligibility/enrollment, benefits, authorizations, and claims of the members/subscribers.