Villacencio, Melvin BSN, RN, ITIL, CSSYB

Experience

Clinical Appeal Nurse (Optum Global)

(September 2019 – February2020)

- Analyze the denials of insurance claims or of coverage for medical treatments or procedures at a healthcare facility.

- Review medical code data and records to determine whether the denial was warranted or whether to move forward with an appeal.

- Weigh other factors such as health care regulations, input from medical staff involved in the patient's diagnosis, and the pre-existing conditions of the patient.

Operating Room Nurse-University of Cebu Medical Center – (Dec 2017– Jan 2019)

-Reviewing the patient’s current and path health history

-Analyse laboratory results

-Assessing the patient’s psychological and physical condition

-Make critical decisions

-Coordinate the patient’s care

-Collaborate with physicians and other healthcare professionals

Senior Team Manager – Cluster Manager OIC (ACCENTURE) Sept 2008 – Dec 2017)

- Improve the operational systems, processes and policies in support of organizations mission, specifically, support better management reporting, information flow and management, business process and organizational planning.

- Manage and increase the effectiveness and efficiency of Support Services (HR, BE, IT and Finance), through improvements to each function as well as coordination and communication between support and business functions.

- Play a significant role in long-term planning, including an initiative geared toward operational excellence.

- Oversee overall financial management, planning, systems and controls.

- Management of project’s budget in coordination with the Program Manager.

- Organization of fiscal documents.

- Regular meetings with Site Director around fiscal planning.

- Supervise and coach office manager on a weekly basis.

- Provide team leadership and coaching.

- Provide the team with a vision of the project objectives.

- Recognize and celebrate team and team member accomplishments and exceptional performance.

- ITIL Certified

- Lean Six Sigma Yellow Belt Certified

- Familiarize the team with the customer needs, specifications, design targets, the development process, design standards, techniques