Emmanuel Jon A. Marcelo, RN, BSN, CPC

Flat #** Building 33 26b st. Al Rigga,

Deira, Dubai, UAE

+971-**-***-****/+971-**-***-****

adbr1y@r.postjobfree.com

Place of Birth: Metro Manila, Philippines

Date of Birth: 12th of October, 1989

Citizenship: Filipino

Passport No: EC7948388

WORK EXPERIENCE

Iranian Hospital- Accumed RCM (Apr 2018- Present

-Preapproval Officer

Provides Preapprovals and reapprovals on the counter while providing insurance customer service to patient on a day to day operations

Communicates with doctors for insurance queries for faster response

Works on front desk counters, back office, auditing, and all operations in the outpatient whenever needed by client.

Communicates with Patients, providers, and payers to facilitate work process and lessen delays

Audits the entire outpatient department as well as oversee cashier and billing activity

Communicates with offshore team and provides support on claims submission

Assists the supervisor with managing, working process, and operational needs whenever necessary

Ministry of Health Al Baraha Hospital (Mar 2016-Jun 2017)

-Senior Insurance Coordinator

Coordinates with the Doctors, Nurses, Radiologists, hospital staff, clerks, and patients in acquiring accurate information for approval

Acquires approvals and guarantee of payments from payers as per MOH circular resolution No. 1004 year 2015

Provides payers the necessary information to cover patients' condition

Submits claims to the payer for adjudication

Trains insurance coordinators in various MOH facilities in Sharjah, Ajman, Ras al Khaimah, and Fujairah and provides support

Executes systems checking for E-claims submission with the use of ICD-9-CM, ICD-10-CM, CPT and HCPCS codes

Globemed Gulf Healthcare Solutions LLC (2015)

- Claims Adjuster

In charge of correcting Remittance Advice and submits to HAAD and DHA post office

Adjudicates, and adjusts Outpatient, Resubmission, and Paper claims with ICD-9-CM, ICD-10-CM, CPT and HCPCS codes

Enters Paper claims into the system and assigns ICD-9-CM, ICD- 10-CM, CPT and HCPCS codes

Dispatches, closes and creates bordereau for batches for claims submission

LICENSES AND QUALIFICATIONS

2015- 2020

AAPC Certified Professional

Coder (CPC)- ICD-10-CM

Proficient

Dubai UAE Chapter Member

#01384831

2014- 2015

Dubai Health Authority (DHA)

Registered Nurse- Lic. No.

DHA-P-0067142

2010-2017

Board certified RN Philippine

Nursing Licensure Examination

– Lic No. 0682383

2011-2014 ANSAP Certified IV

Therapy Nurse

2011- 2013

Department Of Health (DOH)

Certified Basic Life Support and

First Aider

2013

Wellpoint Certified EncoderPro

Medical Coder

POSTGRADUTE EDUCATION

THE WHARTON SCHOOL UNIVERSITY

OF PENNSYLVANIA- UNITED STATES

-MBA Coursework (2012)- Operations

Management, September- December

2012

EDUCATIONAL ATTAINMENT

FAR EASTERN UNIVERSITY-MANILA

-Bachelor of Science in Nursing (2010)

-Associates in Health Science

Education (2008)

AWARDS RECEIVED

University of Pennsylvania

2013 Operations Excellence

Award - Top 1% Overall Score

2012 Coursera Statement of

Accomplishment with distinction

WORK EXPERIENCE (Continued)

Silvercoast Construction and Boring LLC (May 2013- Jan 2015)

-Site Nurse

Discusses health related concerns to the safety department meeting

Initiates First Aid treatment and tends to emergency situations

Performs triage to queuing situations

Responsible for procurement of medical supplies.

Arrange transportations for workers in emergency\ies

Conducts trainings on worker's health safety

Supervises safety helpers on emergency procedures

Provide medications for employees as needed Responsible for monitoring and recording the patient's condition

Assist all injured employees to the nearest hospital

Initiates, updates, and maintains all worker's medical and other similar records

Accenture Inc.- Bluecross Blueshield of Georgia/ Anthem Bluecross New York, Wellpoint Inc. (August 2011- January 2013)

-Approval Certification Specialist/ Healthcare Insurance Analyst/ Utilization Management Reviewer (UMR)

Processes ICD-9-CM, CPT, and HCPCS codes according to client requirements and adheres to Healthcare Insurance Portability and Accountability Act of 1996 (HIPAA)

Initiates and creates preauthorization

Responsible to provide support to the clinical team and client team to assist in the promotion of quality member outcomes, to optimize member benefits, and to promote effective use of resources.

interprets financial and statistical data

Supports the procedures that ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.

Gathers information and conducts pre-review screening under the guidance and direction of US licensed health professionals.

Perform data entry and research in various systems and tracking tools.

Apply knowledge of processes and related systems to assist in identifying, assessing and resolving issues/problems.

Assess and resolve non-standard and standard issues or problems.

Able to take roles as Point of Contact, Floor walker, Client Relations Specialist, Subject Matter Expert, 1 year Supervisory and Leadership Experience capable of leading a team of 13 coders

Proficient in the use of PCs, spreadsheets and other software applications (MS Office)

Provides Customer Service to US licensed Healthcare Professionals.

Accenture, Inc

2012 Top Performing Agent -

Overall Performance

2012 Top Performing Agent -

Perfect Attendance

2012 Drives to Add Value-

Performance Recognition Award

2012 Professionalism,

Resilience to Change, and Teamwork-

Performance Recognition Award

2013 PWD Champion -

Person With Disabilities Advocate

2013 KX Champion Silver -

Knowledge Exchange Global Company

Participant

St. Joseph's College

2005 Loyalty Awardee

PROGRAMS, SEMINARS, & TRAININGS

American Academy for

Professional Coders (AAPC)

27/6/2016 ICD-10-CM General

Code set Training Course

18/3/2016 Establishing

Medical Necessity of E&M

Globemed Gulf Courses

01/01/2016 Globemed IT Security

09/30/2015 Revenue Cycle

Management

10/15/2015 Medical, Commercial &

Corporate Confidentiality

09/28/2015 Fundamentals of

Customer Service: Communication

methods: Rules and Etiquette

Accenture Training Courses

1/11/2013 Web Based Course:

EMR Reporting and Analytics

1/11/2013 Web Based Course:

Healthcare Reform and its Impact on

Payers

1/10/2013 Web Based Course:

Information Security

12/5/2011 Instructor Led Session:

Offering of Effective Business

Communication

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