Customer Service Insurance
Resume:
ELISA T. MANALANG Bachelor of Science in Nursing Mobile #: (050-***-****
Al Fahla St. Passport Road, Abu Dhabi
E-mail: **********@*****.***
Medical Insurance Coordinator and Billing Specialist
Responsible in generating invoices for billing and uploading the xml files into HAAD ‘Green rain’ portal
Communicate and deal with different insurance network for any clarification, policies and issues.
Experienced in doing re-submission, make sure proper code and justification are in place in order to
maximize collection
WORK EXPERIENCES
Company Name : Advanced Cure Diagnostic Center
Date Inclusive : October 2010 – Present
Address : Al Bateen Area, Abu Dhabi, UAE
Medical Insurance Coordinator (Billing/Re-submision/Approval)
• Effectively provides a high level of customer service both internally and externally. Ensures patient experiences related to billing/collections rival the care received in client facility.
• Performs customer service to patients and handles inquires.
• Verify insurance then determines eligibility for services, and informs patients regarding financial responsibility
• Send approval request to Insurance companies, and coordinate it with the patients.
• Posts charges and payments into billing system; ensures fee schedule is current; performs ICD-9 and CPT
coding, and maintains billing manuals.
• Enters data and maintains referral information for providers.
• Compiles information to audit month-end reports on charges billed, procedures performed, and unbilled procedures.
• Receives and responds to customer inquiries and complaints that may pertain to billing, claims' and claim denials.
• Explains billing terms accurately in simple language so that customer can understand the explanation and how it applies to the particular question.
• Coordinates resubmission of claims when f/u indicates such action is necessary.
• Takes note of recurring questions or problems that may be resolved or alleviated by changes in policy or procedures.
• Prepares and submits clean claims to various insurance companies either electronically or by paper.
• Answers questions from patients, clerical staff and insurance companies.
• Identifies and resolves patient billing complaints.
• Prepares, reviews and sends patient statements
• Evaluates patient’s financial status and establishes budget payment plans. Follows and reports status of delinquent accounts.
• Performs daily backups on office computer system
• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
• Processes payments from insurance companies and prepares a daily deposit.
• Participates in educational activities and attends monthly staff meetings.
Company Name : NAS Administration Services
Date Inclusive : January 2008 – October 2010
Address : Salam St, Abu Dhabi, UAE
Sr.MedicalClaimsProcessor/TeamLeader
• Supervise daily work of team members, support and motivate them to achieve individual and team target.
• Receives, and adjudicates medical claims for processing
• Monitors all invoice batches to be complete and processed, Coordinate to different providers for clarification of different issues regarding the claims.
• EDI, or manual documents for pertinent data on claim for complete and accurate information (eg.date of service, provider’s number, charged amounts, medical procedure codes, fee codes, etc.
• Researches claims for appropriate support documents and documentation. Analyzes and adjusts data, determines appropriate codes, fees and ensures timely filing and contract rates are applied
• Ensures claims/bills meet eligibility, benefit and Medicare requirements. Processes hot provider files within time line.
• Identifies multiple service, multiple rates and completes claims/bills, pends, voids, refunds, and/or approves for payment.
• Receives calls from members and/or tracks on-line communications, providers, explains reason(s) claims have been denied or pending, by utilizing benefit plan agreement, eligibility, possible coordination of benefits, worker’s compensation and policies and procedures. Explains the appeal process if necessary.
• Provides one on one customer service in obtaining and providing information to the member and/or provider. Documents and tracks on-line communications.
• Responds to and researches vendor and member problems, questions and complaints using on-line systems.
• Provides training as assigned to new employees as well as cross training in all phases of claim and referral department processes.
• Performs additional assignments such as, special projects related to the claims & referral department
EDUCATIONAL ATTAINMENT
University / School : Collegiate Central Luzon Doctors Hospital
Course / Degree : Bachelor of Science in Nursing Address : Carangian, Tarlac City, Philippines Date Inclusive : June 2003 – March 2007
University / School : Tarlac Christian School
Course / Degree : High School Diploma
Address : Matatalaib, Tarlac City, Philippines
Date Inclusive : June 1995 – March 1999
HIGHLIGHTS OF QUALIFICATIONS: Dependable and flexible that can easily adjust with changing situations, willing to learn and trainable, Very innovative and can maximize the use of computer as a business tool: knowledgeable in Microsoft Office, Have a good interpersonal skills.
SEMINARSATTENDED: HAAD Coding, CPT Coding and E&M Coding
Medical Coding Workshops: HAAD 2009 (Sponsored by HAAD and NAS Administration Services)
CPT, HCPCS & ICD 9 CM in General Guidelines & Rules and CPT & ICD 9 CM Integumentary System Coding CPT & ICD
9 CM Musculoskeletal (including Spine and Spinal Cord) & Nervous System Coding
CPT & ICD 9 CM OB-GYN (ante-, peri- & post-natal & childbirth), Pediatrics & Genitourinary System Coding CPT& ICD
9 CM Endocrine & Digestive System Coding.
PERSONAL INFORMATION
Date of Birth : August 16, 1981
Citizenship : Filipino
Passport no. : WW0231838
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