Insurance Specialist Surgical Coordinator

CURRICULUM VITAE

Jojie B.Canlas C.P.T.

c ***********@*******.***

Cell phone# 786-***-****

Summary:

As a Sr.Insurance Specialist Grievance and Claim with an organizational effectiveness, efficiency,safety and skills office knowledgeable in administration and procedures, A responsibility to develop intra-office communication protocols, streamlining administrative procedures, inventory control, supervision and task delegation. Professional who is multiple task .Experienced in handling a wide range of administrative and executive support related tasks and able to work independently with little or no supervision. Well flexible and enjoy the administrative challenges of supporting an office of diverse people. Reference and understand internal health plans’ policies and procedures to frame decisions.Interpret regulations.Resolve cases and make critical decisions.Finalize resolution letters Manage all duties within regulatory time-frames.Communicate effectively to hand-off or pick-up work from colleagues.Work within a framework that measures productivity and quality for each Specialist against expectation.

Education :

Certified Pharmacy Technician

Miami Lake Educational College

2020-2022

Associate Science Hotel and Restaurant Management

Our Lady of Fatima University

Valenzuela, Metro Manila Philippines

Undergraduate

Bachelor of Science Accounting Major in Banking and Finance Far Eastern University

Nicanor Reyes, Manila Philippines

1996-Undergraduate

Certificates:

-Phlebotomy Certificate Technician

-American Heart Association Cardiopulmonary Resuscitation.

-American Heart Association Automated external defibrillator .

-American Heart Association BLS for Healthcare Provider.

-American Society for Clinical Laboratory Science for Transporting Dangerous Goods.

-GCP Training

-OSHA Training

1 Jojie Canlas Curriculum Vitae

Professional Experience:

Office Manager -Sr. Claim and Grievance December 5, 2016 –Current Interventional Pain Management

/ Laudan Partners Inc.

1300 SW 27 Ave

Miami, Fl. 33145

Major Duties and Responsibility

● Responsible for hiring and training office staff.

● Addresses staff issues and conducts regular performance reviews.

● Makes sure that the facility is clean.

● Oversees the selection of equipment used in the facility and ensures that it works properly.

● Supervises the selection and ordering of supplies.

● Oversees the financial aspects of the business, such as billing, banking and accounting.

● Ensures that her staff uses the correct coding when designating the diagnosis or results of procedures used.

● Makes sure that educational pamphlets and brochures of services are readily available for patients.

● Oversees the development and implementation of a marketing practice while maintaining an appropriate office environment.

● Meets departmental goals regarding collections, productivity and customer service.

● Attends departmental staff meetings and other meetings, as assigned.

● Serves on internal department committees.

Surgical Coordinator -Billing and Coding December 5, 2016 – Present Interventional Pain Management

/ Laudan Partners Inc

1300 SW 27 Ave

Miami, Fl. 33145

Major Duties and Responsibility

2 Jojie Canlas Curriculum Vitae

● Pre-registers patients scheduled for medical services by Central Scheduling; identifies missing elements and contacts Patient Business representatives.

● Performs appropriate pre-registration functions including calling physician offices, insurance payers and the patient/guarantor, as necessary.

● Assures third party coverage is verified and certification of services is obtained.

● Maintains a working knowledge of third party reimbursement requirements and regulations.

● Efficiently and accurately gathers and inputs patient/guarantor demographic and financial information.

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● Contacts appopriate payers, verifies benefits and obtains necessary authorizations.

● Coordinates patient services and information with case managers, ancillary departments and physician’s staff.

● Identifies customer service issues and resolves or initiates necessary follow-up.

● Explains necessary forms to and obtains signatures from patient/guarantor; answers basic customer billing questions.

● Utilizes appropriate reports to contact insurance payers for resolution to accounts that are pending or denied.

● Documents insurance benefits, co-payments, deductibles and self-pay portions in the account to allow for collections due.

● Contacts admitting physician to obtain authorization, diagnosis and procedure detail as necessary; documents authorization and benefit information in registration system.

● Obtains copies of relevant documents including insurance cards and photo. Knowledge of the following:

-Registration and scheduling systems

-Electronic verification tools

-Web-based resources

-Medical necessity screening process and appropriate systems ICD-10 and CPT codes

● Adheres to Patient Financial Services self-pay policies including completion of Guarantor Financial Statement Application, explanation of payment options and collections of monies due and cash handling.

● Performs department cashiering functions and point-of-service transactions.

● Assists Director with cross-training staff as well as cross-trains departments.

● Participates in training of new team member.

● Processes departmental reports, as assigned.

● Possesses excellent interpersonal skills and ability to work in a team environment.

● Respects the rights and privacy of others and holds staff member information in strict confidence.

● Maintains regular attendance and complies with time and attendance policy and procedure.

● Ensures compliance with all regulatory standards including Federal, State, local and Joint Commission.

● Prioritizes workload to manage multiple priorities.

● Uses problem-solving skills to meet goals.

● Enhances professional growth by participating in educational programs, current literature and/or workshops.

Insurance Specialist Verification and Claim Coordinator December 5, 2016 – Present Interventional Pain Management

/ Laudan Partners Inc.

1300 SW 27 Ave

Miami, Fl. 33145

Major Duties and Responsibility

• Accurately enter insurance information into computer system.

• Responsible for pre-certification/ authorization and insurance verification for all patients.

• Research, follow up and resolve open & pending authorizations in a timely manner

• Calculate cash estimates for patients on upcoming visits/ procedures.

• Contact patients regarding financial obligations.

• Documents activity in the patient accounts.

• Concisely, precisely and accurately document all information.

• Maintain clear communication with patients as well as insurance companies.

• Answer phone for incoming calls, make outgoing calls and assist Call Center as needed.

• Maintain strict confidentiality of patient and center related business.

• Obtain prior authorization for procedures.

• Scanning medical documents into patient accounts.

• Perform other responsibilities .

Clinical Research Coordinator December 5, 2016 – Present AMPM Research Clinic

Major Duties and Responsibility

● Coordinates with Principal Investigator, department, and central administration to help ensure that clinical research and related activities are performed in accordance with Federal regulations and sponsoring agency policies and procedures.

Protocol Preparation & Review

● Reviews and comprehends the protocol.

Preparation of Scientific Proposal

● Assists the PI in study feasibility assessments as requested. Protocol Preparation & Review

● Reviews and comprehends the protocol.

● Attends investigator meetings as required or requested by the PI.

● Collaborates with the PI to prepare IRB/HRPO and any other regulatory submission documents as required by the protocol. Prepares other study materials as requested by the PI. These study 4 Jojie Canlas Curriculum Vitae

materials include but are not limited to the informed consent document; case report forms

(CRFs), enrollment logs, and drug/device accountability logs.

● Establishes and organizes study files, including but not limited to, regulatory binders, case report forms, study specific source documentation

Conduct of Research

● Reviews and develops a familiarity with the protocol, e.g., study proceedings and timelines, inclusion and exclusion criteria, confidentiality, privacy protections.

● Assists PI in communication of study requirements to all individuals involved in the study. Provides appropriate training and tools for study team members. Documents date of training and signatures of study personnel trained on study specific training log. Reporting

● Promotes the ethical conduct of research by reporting good faith suspicions of misconduct in research as defined within Washington University’s Research Integrity Policy and other misconduct as described in Washington University’s Code of Conduct. Project Closeout

● Assists the Principal Investigator in submission of accurate and timely closeout documents to applicable Federal agencies, University entities, and the sponsoring agency in accordance with Federal regulations and University and sponsoring agency policies and procedures. Research Experience:

Study Phase :3

A multicenter, double-blind, randomized, placebo-controlled, Phase 3 study to assess the efficacy and safety of oral BPS-314d-MR added-on to treprostinil, inhaled (Tyvaso®) in subjects with pulmonary arterial hypertension

Study Number: BPS-314d-MR-PAH-302

Phase 4 Study

A randomized, double-blind, placebo-controlled, prospective, multicenter, parallel group study to assess the safety and efficacy of macitentan in patients with portopulmonary hypertension (PoPH) OPUS Registry

US-based, observational, drug registry of Opsumit® (macitentan)new users in clinical practice. Phase IV

5 Jojie Canlas Curriculum Vitae

Gloria A-F Global Registry on Long Term Oral Anti-Thrombotic Treatment in patient with Arterial fibrillation (PHASE II-III)

Phase IV

Prospective, Single-Arm, Open-Label Study to Measure Outcomes in Patients with Pulmonary Arterial Hypertension not on Active Treatment Measuring Outcomes In Patients with Pulmonary Arterial Hypertension not on Active Treatment

(MOTION)

A Global Registry to Evaluate the Long-Term

Effectiveness of Neurostimulation Therapy for Pain Sponsor: Boston Scientific Neuromodulation Corporation Patient Registry of Intrathecal Ziconotide Management (PRIZM): An Open-Label, Long-Term, Multi-Center, Observational Study of PRIALT® (ziconotide) Solution, Intrathecal Infusion, in Patients with Severe Chronic Pain

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