Healthcare RCM Specialist | Medical Billing, Claims & AR Follow-Up
Metro Manila, Quezon City, Philippines
Healthcare Revenue Cycle Management (RCM) Specialist with experience in medical billing, claims processing, accounts receivable management, insurance eligibility verification, denial resolution, appeals, and AR follow-up. Committed to improving reimbursement accuracy, reducing claim denials, and supporting efficient healthcare revenue cycles.
Med-Metrix, full_time
Jun 2025 to Sep 2026
• Reviewed, analyzed, and processed medical claims in compliance with insurance policies, provider agreements, and regulatory standards. • Verified patient eligibility, benefits, and pre-authorizations to ensure accuracy and policy compliance. • Investigated and resolved billing and coding discrepancies (ICD-10, CPT, HCPCS) to minimize denials. • Prepared and submitted reconsiderations and appeals to payers, successfully overturning denials and securing reimbursement. • Collaborated with healthcare providers, insurance carriers, and internal teams to expedite claims adjudication. • Identified denial trends and recommended process improvements to reduce turnaround time and increase accuracy. • Maintained HIPAA compliance and safeguarded sensitive health information. • Consistently met KPIs based on claim accuracy and productivity, achieving accuracy rates while processing large claim volumes efficiently.
Conifer GBC, full_time
Feb 2025 to Jun 2025
• Ensured timely claim submission by validating patient and insurance information. • Corrected denied/rejected claims and secured additional documentation for resubmission. • Negotiated with carriers to overturn denials, maximizing reimbursement. • Collaborated with billing and clinical teams to improve claim accuracy and efficiency. • Identified recurring claim issues and provided actionable insights to leadership.
R1 RCM, full_time
Sep 2023 to Jan 2025
• Delivered patient support on billing inquiries, claims disputes, and payment concerns. • Clarified Explanation of Benefits (EOBs), improving patient understanding of financial responsibility. • Escalated unresolved disputes to ensure proper resolution. • Conducted proactive outreach to patients with outstanding balances, improving collections. • Verified coding accuracy and coordinated corrections with billing teams. • Structured flexible payment plans aligned with hospital policies.
TaskUs , full_time
Feb 2022 to Aug 2022
• Protected platform integrity by reviewing user-generated content for compliance. • Ensured accurate ad categorization, improving content placement and user experience.
Teleperformance, full_time
Mar 2021 to Aug 2021
• Delivered real-time support for refunds, replacements, and order inquiries. • Guided customers on product details and availability, recommending alternatives when needed. • Investigated and resolved delayed orders, late refunds, and incorrect shipments.
Manulife BPS, full_time
Oct 2019 to Nov 2020
• Supported policyholders with health insurance coverage and claims inquiries. • Verified coverage for medications, equipment, and ambulance services. • Processed claims for drugs, optical services, and medical equipment. • Provided administrative support for eligibility, benefits, and dependent updates. • Monitored coverage usage to ensure accurate benefit tracking.
Teletech, full_time
Aug 2018 to May 2019
Concentrix, full_time
Sep 2017 to Mar 2018