Paul L. de Leon
MEDICLINIC INTERNATIONAL-DUBAI U.A.E
MEDICAL APPROVAL / CUSTOMER SERVICE
Insurance Department (June 2018 up to Present)
Arrange invoices, enter all the data with the corresponding medical report with correct ICD and CPT code. Call and send mails to insurance to get the approval soonest. Inform the nurse or patient with the correct information from insurance.
Rectify and amend such rejection from insurance referring on all the medical reports given by the medical team for the case to be approved.
Coordinate will all insurances and sort out problem to those insurance that is not yet empaneled to provider. MAJID AL FUTTAIM HEALTHCARE-DUBAI U.A.E
MEDICAL APPROVAL COORDINATOR / CLAIMS SUBMISSION / CUSTOMER SERVICE Insurance Department (1 year term) January 2017 up to May 2018
Approve cases for OP/IP/Day case with the correct diagnosis of ICD 9 / ICD 10 as per physician’s justification. Thru different system (Nextcare Pulse, Alico, NAS, Amity-Fortune, AXA, Neuron, Mednet EBP, eclaimlink, emails etc. )
Coordinate to all insurance to accomplish Outpatient / Inpatient pending request through Eclaimlink DHPO, mails or verbal through phone. Modify/amend claims referring to medical report, lab tests done provided to justify claims and prepare invoices/costs estimates to be sent to all insurances.
Submit claims monthly obtaining the correct data, invoice amount, proper ICD and CPT encoded with correct portal
PRIMACARE MEDICAL CENTER-DUBAI U.A.E
CLAIMS SUBMISSION / APPROVAL COORDINATOR / FRONT DESK INSURANCE COORDINATOR Insurance Department (1 year term) June 2015 – December 2016
Analyze and submit claims with correct data as per the patient information and medical record.
Coding and processing claims for payment, ensuring all information is supplied previous to eligible payments are made.
(ICD-10, CPT 4 and HCPCS DHA E-claims portal)
Secures authorizations for all medical cases in a timely & thorough manner to maximize timely billing. IRANIAN HOSPITAL-DUBAI U.A.E
SUBMUSSION / RESUBMISSION AND RECONCILIATION ANALYS Insurance Department (1year term) May 2014 – May 2015
Analyze / submit / resubmit fresh claims and paper claims to companies (INS or TPA) thru E-claims system or DHPO.
Understand type of rejection, generate justification for type correction and type internal complaint, give proper diagnosis as per the doctor medical justification, rectify clerical error, Generate XML and upload to DHPO
Resubmission of contested rejections done accordingly and monitor if companies will pay these invoices to rectify our records correctly.(DHA E-claims portal)
Al Rigga Dubai, United Arab Emirates
Date of Birth: May 20, 1988
Visa Status: Employment Visa
Civil Status: Single
Language: English, Filipino
I have experience in insurance and medical
business office, sales support, marketing executive and call center working in a various environment from admin staff up to outdoor field.
ACCOUNT SALES EXECUTIVE / MARKETING OFFICER / CUSTOMER SERVICE Marketing & Sales Department (3 year term) June 2010 – January 2014
Manage various projects working to large enterprises, contractors and event organizers local and international. Meeting client requirements and expectations to satisfy all the exhibitors companies. Handle and market to a wider range of connections and channels globally.
Budget management, controlling expenses but meeting high standards of materials by sorting out/canvassing different suppliers to accomplish the assigned tasks.
Organize regular client meetings to discuss their requirements, do a case presentation during meeting. Close the million dollar deal and prepare quotations with the proper mark up from raw estimation up to the final contract costs for the whole setup duration of the event.
Ensure that all the requirements are goal met following the correct floor plan up to the whole architectural design of the convention centers where the event will hold. Resolve any problem based on the agreed contract that agreed between the two parties, contractor and organizers. Multitask and implement strict deadlines.
Monitor all the progress of the material production prior to the agreed setup and canvass for the additional item outsourcing to meet the clients item standard. Plan for the enough manpower for the setup, materials trucking upon delivery and dismantle.
Meet all the clients/exhibitors needs. Coordinate to the venue for all the electrical requirements by preparing electrical floor plan, daily monitoring to the project officer for the remaining amenities supplies. SKILLS AND QUALIFICATIONS
Strong accomplished experience in insurance and medical business office. Good knowledge of all plans and medical invoices, medical terminology and insurance practices.
Skilled in processing of claim forms for payment ensuring all information is supplied previous to eligible payments are made. Meeting requirements for accomplishing deadlines in high volume of works monthly.
Able to perform data entry of all interactions. Maintains record of all the insurance lists status which is pending, approved, query or partially approved.
Outstanding telephone etiquette that answers query to all of the pending insurance. Excellent in written and verbal communication skills dealing in various insurance agents, medical professional, clients.
Proficient in Computer Programs and applications Microsoft word, excel, power point, dealing with different provider system and insurance.
Outstanding ability to maintain strong relations with Physicians, employees, patients and insurance companies. Correlate each case to resolve as early as possible to gratify patient on the services to be render.
Remarkable ability to relate to people from different cultural backgrounds and/or nationalities as being in the medical provider we renders care to everyone.
Highly adaptable, flexible, mobile, positive, resilient, patient risk-taker who is open to new ideas.
Extremely productive in a high-volume and high-stress environment working directly with patient, medical professionals and insurance agent and network.
SEMINARS AND TRAININGS
Customer Service Training - Majid Al Futtaim, Dubai UAE - October 2017
Fraud Awareness - Majid Al Futtaim, Dubai UAE - August 2017
Stock Trading Online Academy - Knowledge Village, Dubai UAE - May 2017
Social Media Masterclass - Al Rigga, Dubai UAE - March 2018 EDUCATION
Bachelor of Scieng in Nursing
Emilio Aguinaldo College-Manila, Philippines
School year : June 2005 – March 2010