MARIFEL P. AGAD

E-mail: adizhf@r.postjobfree.com

Mobile : +971**-*******

Personal Details:

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Single

Language: Tagalog, English

RESUME

CAREER OBJECTIVE

To serve with a progressive organization in a challenging and rewarding position, utilizing and exploring my academic knowledge and skills to contribute towards the growth of the organization and achieving its mission.

PROFESSIONAL FIELDS

Bachelor of Science in Nursing

PROFESSION

Registered Nurse in Philippines

QUALIFICATION AND SPECIALTIES

Strong computer skills in data entry, coding and knowledge of Electronic Medical Record software, microsoft applications

Have self-determination, organized, efficient, have good interpersonal skills

Highly competent in English both spoken and written

Analytically inclined, flexible, a fast learner.

Looking forward on career advancement.

With high intellectual capabilities, hardworking.

Always willing to learn for better improvement.

Can handle multitask activities that is needed in the field

EMPLOYMENT HISTORY:

INSURANCE COORDINATOR / MEDICAL RECEPTIONIST

1.RIAZ SPECIALIST MEDICAL CENTER

December 2016 – October 2020

2.SPECIALIST MEDICAL CENTER

March 2016 – September 2016

3.AL JAMEELA POLYCLINIC

January 2014 – January 2016

4.MEDICURE POLYCLINIC

November 2005 - October 2013

Duties and responsibilities:

Deal with queries, prepare insurance claim forms and associated correspondences, ensure coverage of claims

Responsible for review & empanelment of Medical Insurance’s contracts, renewal, review of tariffs,

addition of clinicians to each empanelled medical insurances as well as provides training for utilization

of new portals; ensuring that each approver will be well versed of new portals and updating the team on new circulars

Strong knowledge on EMR applications such as Mediware, Medas and Claimax systems; had the EMR direct access to:

Reception / Front Office

Approvals / Claims processing

Submissions/Resubmission

Accounts / Billing/Generate claims

Seeking approvals, submissions and re-submissions through:

E-claimlink

Major Medical Insurances Portal i.e: Pulse, Al Buhaira, Neuron, ADNIC, etc.,

Gather patient’s personal and insurance information and direct them to the proper waiting medical rooms

Coordinate with insurance companies for obtaining information of new policies and their coverage

Verification of insurance eligibility ensuring coverage of claims, train and educate staffs in insurance matters and guide them for correct usage of claim forms

Explaining coverage of medical benefits, eligibility and entitlements to patients when required

Obtain authorizations from respective insurance providers as per different insurance policies using proper CPT and ICD coding for required treatment and services

To coordinate, liaise and network between insurance companies regarding eligibility and approval status and to obtain accreditation as provider

Coordinate with the insurance companies concerning network agreements, negotiation, revision of tariffs, contract renewal and outstanding balance

Handles co-pay, invoicing for insurance processing and billing

Reviewing patient bills for accuracy and completeness, and obtaining any missing information

Preparing, analysis of claims prior to submission to reduce claim rejection, ensuring completion of documents before processing claims, submission and re-submission on time

Strictly commit to contractual terms and conditions for each payer and TPA.

Follow DHA guidelines and maintain documentation for DHA audit at all times.

Strictly adhere to the turnaround time of submission of each insurance company.

Review claims to make sure that billing requirements are met, update accounts as necessary, answers inquiries, and make recommendations for resolution.

Process insurance claims in a timely manner.

Maintain strict confidentiality related to medical records and other data

Prepare rejected claims for resubmission with proper codes and format to insurance companies.

Review claims details and analyse reasons for denials.

STAFF NURSE

Leona O. Lim Memorial Hospital

Bohol, Philippines

January 2002 September 2005

Duties and Responsibilities

Performs direct Nursing care procedures which includes bedside nursing, hygiene, pre and postoperative nursing care, as well as admission and discharge duties.

Administers medications.

Observes, records and reports patient's symptoms, conditions and progress of treatment and therapy.

Ensures quality care to every patient.

Prepares patient for, and assist physicians with diagnostic and therapeutic procedures for both normal and specialized treatment cases.

Operates diagnostic machines.

Maintain records reflecting patient's condition, medication and treatment.

Coordinates with other departments of the hospital regarding patient care.

Assist in education and rehabilitation of patients and their families in relation to physical and mental health.

Set up treatment trays, prepare instruments and equipment, and ensures adequate medical or hospital supplies and availability of proper equipment and instruments.

Attend seminars, trainings and updates in order to know the latest trends about our profession.

TRAINING & SEMINAR ATTENDED

CPT AND ICD CODING IN RASHID HOSPITAL (2013)

DECLARATION

I hereby declare that above mentioned data are true to the best of my knowledge and belief.

REFERENCE

Available upon request

Contact this candidate