Patient Care Coordinator/ Medical Billing/Prior auth/Claims Processing
Quirino
Good day! My name is Adarlina Nepomuceno, and I have over three years of experience in the healthcare industry as a Patient Care Coordinator. In my role, I was responsible for processing prescription refill requests, coordinating and scheduling medication deliveries, verifying insurance benefits and coverage, processing test claims, checking the status of prior authorizations, and assisting patients with payment arrangements to ensure they received their medications without unnecessary delays. I also worked closely with healthcare providers and clinicians by sending follow-up emails, coordinating prescription clarifications, and ensuring all required documentation was completed promptly. Throughout my experience, I have maintained strict compliance with HIPAA regulations, protecting patient confidentiality while delivering compassionate, accurate, and efficient support. I am HIPAA certified and understand the importance of handling sensitive medical information with professionalism and care. What I enjoy most about working in healthcare is helping patients navigate what can often be a complex process. I pride myself on being patient, detail-oriented, organized, and an effective communicator with patients, providers, insurance companies, and internal teams. I am comfortable working in fast-paced environments, managing multiple priorities, and ensuring a seamless patient experience. I am excited about the opportunity to bring my healthcare knowledge, strong administrative skills, and commitment to excellent patient care to your team. I am confident that my experience and dedication will allow me to make a positive contribution to your organization. Thank you for your time and consideration.
Everise Phil. ltd, full_time
Jul 2023 to May 2026
**Patient Care Coordinator** **Everise | Supporting Humana CenterWell Pharmacy** During my time at Everise, I worked as a Patient Care Coordinator supporting Humana CenterWell Pharmacy, where I provided comprehensive support to patients throughout their medication journey while ensuring a high level of customer service and HIPAA compliance. My responsibilities included: * Assisting patients with **prescription refills** and ensuring refill requests were processed accurately and efficiently. * **Scheduling medication deliveries** and coordinating shipment dates based on patients' needs. * Reviewing **insurance claims** by running test claims, verifying claim status, and resolving processing issues when possible. * Verifying **insurance benefits and prescription coverage**, including checking copays and eligibility. * Reviewing **prior authorization** requirements and coordinating with healthcare providers and insurance companies to help facilitate the approval process. * Assisting patients with **payment arrangements** and discussing available payment options for prescription costs. * Communicating with physicians' offices and healthcare providers to obtain prescription clarifications, refill approvals, and required documentation. * Maintaining accurate patient records while ensuring strict compliance with **HIPAA** regulations and protecting patient confidentiality. This role strengthened my skills in patient communication, insurance verification, pharmacy operations, problem-solving, multitasking, and coordinating with healthcare providers to ensure patients received their medications without unnecessary delays.