2005
HRM
BCPD
My Skills and Competencies
Social Media Management
Graphic Designer
Data Entry
Content Creator
Certificates
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My Experience and Education
2023
-
2024
MJ Medical Billing (US Health Insurance)
(Head of Denial Team)
1. Reviews all denial accounts for categorization, level of appeal, special requirements for initiating appeals. 2. Maintains a clinical appeal process for all inpatient denials assuring that proper documentation is provided to support appeals of unauthorized inpatient days or days denied for lack of documentation. 3. Maintains a clinical appeal process for outpatient denials, i.e., outpatient prior authorization denials, radiology denials, HMO denials for specialty care where a referral was not obtained and clinical documentation is required. 4. Utilizes denial reports to assess root causes and identify trends. Share findings with stakeholders. 5. Leads a Denial Management Stakeholders team; monitoring identified issues and progress. 6. Work with highest level of appeal cases; Refer appropriate cases to Physician Advisors and fiscal attorney consultants, and works closely with them on development of second level appeals 7. Coordinates all second level appeals that cannot be referred to attorney consultants. 8. Coordinates timely processing of all appeals at all levels, i.e., initial appeals, second level response, progress reports. 9. Uses InterQual criteria to initiate appeals for patient class related denials.
2021
-
2023
EXL Service Philippines
(Assistant Manager Job Description:)
Team Management:
Supervise and manage a team of customer service representatives and healthcare specialists.
Provide guidance, coaching, and training to team members to ensure they meet performance targets and deliver excellent customer service.
Conduct regular performance evaluations, set goals, and provide feedback to team members.
Operations Management:
Oversee day-to-day operations of the healthcare account, including handling inbound and outbound calls, email correspondence, and other communication channels.
Ensure adherence to standard operating procedures (SOPs), compliance with healthcare regulations (such as HIPAA), and company policies.
Monitor key performance indicators (KPIs) such as call metrics, productivity, and quality standards.
Client Relationship Management:
Serve as the primary point of contact for the healthcare client, maintaining a strong relationship and addressing any concerns or issues promptly.
Collaborate with the client to understand their requirements, discuss performance metrics, and identify areas for improvement.
Quality Assurance:
Implement quality assurance processes to evaluate the accuracy and effectiveness of customer interactions, documentation, and data entry.
Conduct regular quality audits, provide feedback to team members, and implement corrective actions as needed.
Reporting and Analysis:
Generate reports and analyze data related to team performance, client satisfaction, and operational efficiency.
Use data insights to identify trends, recommend improvements, and drive strategic decision-making.
Training and Development:
Coordinate training programs for new hires and ongoing development for existing team members, focusing on healthcare industry knowledge, technical skills, and customer service excellence.
Stay updated with industry trends, regulations, and best practices to ensure the team remains compliant and knowledgeable.
Collaboration and Communication:
Collaborate with other departments such as IT, HR, and finance to address cross-functional issues, implement system enhancements, and streamline processes.
Communicate effectively with internal stakeholders, external partners, and clients to ensure alignment and transparency.
2016
-
2024
Conduent
(BPO Supervisor)
Managed a healthcare account. It highlights the actions taken in team management, operations oversight, client relationship management, quality assurance, reporting, training, and collaboration during the supervisor's tenure.
My Services
Social Media Management
Analyzing engagement data, identifying trends in customer interaction and planning digital campaigns to build community.
Data Entry / Web Researcher
Search the Internet for information on a wide variety of topics.
Content Creator
Promote companies' products and services by developing copy for websites, social media, marketing materials.