Medical Billing Registered Nurse
Resume:
KRISTINE BUYCO RAMOS, BSPT,BSN,RN
Mobile: +1-510-***-****, +1-510-***-****
Email: ac6ac6@r.postjobfree.com
* ******** **. *******, ** 94542, USA
PROFILE
Versatile and highly proficient Medical Billing Analyst (Third Party Billing and Collections for Facility and Individual Provider) with an average of 99.8% quality score and the consistent Top 1 Performer. A dual degree holder: B.Sc. in Physical Therapy and B.Sc. in Nursing with more than 10 years’ experience in the Healthcare Industry. Background includes work with pediatric, adolescent, adult, special children, athletes, geriatric patients and the whole process of Medical Billing.
QUALIFICATION
Registered Nurse in the Philippines
Excellent administrative and analysis function.
Exceptional interpersonal/communication skills and proficiency in time management and admin duties.
Computer literate and experienced in Microsoft Applications (MS Outlook, MS Office).
Passionate team player deeply committed to delivering quality.
Excellent verbal and written communication skills.
Exceptional leadership and guidance counseling skills.
Attentive to details and able to do multi-tasking.
Punctual and able to work on shifting schedules, weekends and public holidays.
Knowledge in ICD 9 and 10
Experienced in Claim Adjustments, Claim Processing, Electronic Claims and Eligibility.
WORK EXPERIENCE
Medical Bill Review Analyst
United Health Group – OPTUM, McKinley Hill, Taguig City, Philippines
June 2014- June 2018
Enter Medical Charges for all care visits.
Review the visit documentation and the charge ticket to ensure all healthcare charges are captured.
Analyze and Interpret medical records documentation to ascertain complete and accurate information.
Enter all required modifiers based on CPT and CMS coding guidelines.
Provide Support to Internal and External Billing Customers/Payers
Analyze, Resolve, Reconcile Billing Issues.
Demonstrate Knowledge of Billing Systems, Tools and Processes.
Manage Invoices and Account Payments.
Ensure Claims Payment Accuracy.
Ensure Recovery of Claims Payments.
Ensure Achievement of Applicable Performance Metrics.
Account Receivable Specialist/ AR Analyst for Medical Billing
E4E Global Services, Fort Bonifacio, Taguig City, Philippines
May 2013 – May 2014
Constantly keep track status of claims and call insurance companies to verify benefit levels.
Ensure the AR days meet industry standards.
Ensure the compliance with all the insurance carriers in claims submission and other areas.
Appeal claims for denials.
Prepare and manage all primary and secondary insurance billings via paper or electronic according to payer specific rules.
Research and resolve Explanation of Benefits rejections (EOB) and other issues with outstanding accounts.
Upload Explanation of Benefits (EOB)
Communicate with physician and insurance company (US based).
Post cash receipts and adjustments needed.
Read and understand departmental SOP’s for working denials or correspondence.
Utilize insurance company websites to check benefit coverage for patients.
Basic knowledge in ICD 9 and ICD 10.
Private Therapist/ Nurse
Abdon Residence, Laguna, Philippines
April 2010 – February 2013
Assists the patient in her day to day routine.
Assess the muscles and bone condition of the patient.
Prepare activities or exercises that will enhance the muscle and bone condition of the patient.
Prepare therapy procedures and programs.
Examines the capability of the patient to move.
Documents the progress of the patient.
Conduct examinations and exercises from time to time
General administrative duties
Physical Therapist / Special Education Teacher
Handle with Care, Health and Wellness Center, Muntinlupa City, Philippines
May 2008 – April 2010, Part-time
Assess and record performances and behavior of each child / young adult every session.
Formulate individual or group workshops for the children or young adults in coordination with the rehabilitation team.
Participate in case conferences conducted at home which discusses progress or observations with children.
General administrative duties and other duties assigned.
Clinical Physical Therapist
Galang Medical, Pasay City, Philippines
April 2006 – April 2008
Provides treatment that improves patient mobility, relieves pain, and prevents or lessens physical disabilities of patients.
Evaluates neuromuscular, musculoskeletal, sensory motor, cardiovascular, and respiratory functions as well the overall function ability of various patients.
Educates the patient with therapeutic exercises to prevent dysfunction as well as for the development, improvement, and restoration or maintenance of muscle strength, endurance, mobility or flexibility, relaxation, coordination and skill.
Provide comprehensive management programs to facilitate independence.
EDUCATION
Bachelor of Science in Nursing
Emilio Aguinaldo College Manila City, Philippines
2008 – 2010
Activities/Association: College Class President 2008-2009
Caregiver
Training at Power Saver Institute Alabang
2006
Bachelor of Science in Physical Therapy
San Juan De Dios Educational Foundation Incorporated Pasay City, Philippines
2001 - 2006
Activities/Association: Batch Treasurer 2001-2006
VP of Audit, Student Council 2004-2005
Treasurer, Student Council 2003-2004
SEMINARS AND TRAININGS
ICD-10 Overview - July 2015
Impact of ICD-10 Overview - Revenue Cycle – July 2015
Coding Concepts in an ICD-10 World - July 2015
C&E@Work Lesson - Global Anti-Corruption – July 2015
How to Architect an On-the Job Learning – July 2015
2015 Annual Fraud, Waste and Abuse – June 2015
C&E@Work Lesson - Fraud, Waste and Abuse New Hire Training – June 2014
Innovation for Employees – March 2015
Business Writing Skills – March 2015
Coaching CORE Overview for Employees – March 2015
Conducting Conversations with Integrity Webinar – March 2015
Health Care Series- Government funded plans in US Healthcare sector & UHC business - March 2015
HealthCare Series for All - Fraud & Abuse – March 2015
HealthCare Series for All - How Claims are processed by Insurance Company- Lifecycle of a claim - March 2015
HealthCare Series for All - Obamacare & its Impact – March 2015
Communicate for Results – March 2015
Anatomy and Pathophysiology for ICD-10 – March 2015
C&E@Work Lesson - Intellectual Property - June 2014
C&E@Work Lesson - Code of Conduct New Hire Training – June 2014
IV Therapy Training – April 30, May 1 and 2, 2011
Advanced Cardiac Life Support ASHI Accredited – April 2011
Cardiovascular Pharmacology – April 2011
Electrical Therapy: Defibrillation and Cardio version – April 2011
Airway Management: Airway Adjunct and Endotracheal Intubation – April 2011
Basic and Intermediate ECG – April 2011
Basic Life Support: CPR PRO/ AED – April 2011
Understanding Mental Illness Key Concepts in Psychopharmacology & Psychobiology – January 2010
Client Safety, Security and Privacy requirements in Medical-Surgical Nursing Practice – August 2009
Red Cross Basic Life Support and First Aid – September 2009
Asia Premiere Outbound Call Center Peak Tower – January 2008
Philippine Social Institute Finishing Course for Call Center – 2007
Fitness First Philippines Spa Center Training – 2007
Red Cross Basic Life Support and First Aid – 2006
On the Job Training Home for the Aged – 2006
On the Job Training at Christ the King Maternity and Lying-In Hospital, Inc. – 2006
Updates in Neurologic Rehabilitation – 2006
Substantial Discussion and Demonstration on the Use of Orthotic Device – 2006
Substantial Discussion on the Current Updates in the Practice of Physical Therapy – 2006
Peripheral and Spinal Joint Mobilization – 2006
Motor Re-Learning Program – 2006
9th Annual Physical Therapy Interns Scientific Paper Presentation – 2006
On the Job Training in Philippine Sports Commission – 2005
On the Job training in Philippine Orthopedic – 2005
Volunteer in 25th SEA Games – 2005
Current Trends in Knee Rehabilitation and Sports Related Injuries – 2005
8th Annual Physical Therapy Case Conference – 2005
Clinical Pastoral Care Education – 2004
Magna Carta of the Disabled and Physical Therapy Strategic Career Planning – July 2002
AWARDS and ACCOMPLISHMENTS
Top One Performer in Care tracker Charge Entry 2015 - 2017
Top Performer Medical Bill Review Analyst 2014 - 2017, McKinley Hill, Taguig City, Philippines
Top Performer AR Analyst 2013 and 2014, E4e Global Services, Bonifacio Global Taguig City, Philippines
Commendation Award for Exemplary Conduct in Caring for the Elderly 2006
Tahanan ni Maria (Home for the Aged), Carmona, Cavite City, Philippines
Silver Medalist Service Award 2006
San Juan de Dios Educational Foundation Incorporated, Pasay City, Philippines
Silver Medalist Leadership Award 2003
San Juan de Dios Educational Foundation Incorporated, Pasay City, Philippines
Silver Medalist Leadership Award 2002
San Juan de Dios Educational Foundation Incorporated, Pasay City, Philippines
Loyalty Award 2001
St Mary's Academy, Pasay City, Philippines
AFFILIATIONS
Member of Association of Nursing Service Administrators of the Philippines 2011
Member of Philippine Nurses Association 2010
Member of Philippine Certified Wellness Therapist Association 2009 up to Present
CHARACTER REFERENCE:
Lynda Peixoto
Charge Team Lead, Physician Revenue Cycle
Company: United Health Group- Optum
ac6ac6@r.postjobfree.com
Jay Zacarias
Deputy Manager
Company: United Health Group- Optum
ac6ac6@r.postjobfree.com
Cellica Senining
Subject Matter Expert
Company: Flow Health Outsourcing
ac6ac6@r.postjobfree.com
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