Medical Biller | Medical Virtual Assistant

Overview

Looking for full-time work (8 hours/day)

at $4.55/hour ($799.99/month)

Bachelors degree

Last Active

November 27th, 2024 (today)

Member Since

April 11th, 2016

Profile Description

August 2024 - Present
My Mountain Mover
Medical Biller / Medical Virtual Assistant
- Assist client in processing GAP exception requests or single case agreement so the patient would be able to take advantage of their in network benefits if their Insurance does not cover out of network benefits.
- Coordinate with insurance companies to initiate insurance verification.
- Assist client in coordinating with insurance companies to make corrections in claim payment errors.
-Audit and upload latest information, clinicals and/or files to patients profile in prompt EMR.

May 2023 - August 2024
Optum Global Solutions
Subject Matter Expert
-Assisted agents with their inquiries about the process involving prior-authorization requests, credentialing, claims and member’s benefits through chats in MS teams to make sure that they could answer the caller’s inquiries correctly.
- Took over calls where the caller asks for a supervisor and made sure the callers would be assisted with their concern by addressing and monitoring the progress of the issue.
- Assisted in creating escalations and follow up for unattended requests to make sure all work logs are resolved in a timely manner.
- Checked the productivity of agents making sure they are not prolonging their unproductive aux in order to assure that the Service level is kept in a passing score.
-Generated reports for agents’ NPS to keep track of their metrics making sure that they are passing the company’s standard.
-Worked on incoming faxes and forwarding them to the correct department/agents, minimizing repeat callers.
-Coached agents and made sure they understood the process to avoid any future escalations from the clients and/or callers and lessen the detractors.

October 2022 - May 2023
Optum Global Solutions
Clinical coordinator/Customer Service Sr.
- Provided accurate status of their prior authorization requests whether it’s approved, denied or pending with additional information.
Informed callers the reason behind pending prior authorization requests and assist in submitting the missing/correct information to the case manager to make sure that the processing of the authorization request would be processed as soon as possible.
- Assisted callers in processing their prior authorization requests, walk them through the portal and provide alternative ways of submission in case they are having trouble with the portal, advise them of the timely filing to avoid future issues and/or complaints.
- Offered options of peer to peer review and/or appeals incase their authorization request has been denied, emphasized importance of going through peer to peer review before going through an appeal to make sure that the callers understand that they do have an option to overturn the decision of their authorization request.
- Sent out prior-authorization decision letters to providers and/or members if requested.

July 2018 - October 2022
Optum Global Solutions
Clinical Coordinator
- Generated Referrals for Healthy living plans or diet plans and assigned them to the next available nurse per state to make sure that the nurses will be able to contact the member and discuss the plan.
- Monitored Referrals for members that are still inpatient until the members have been discharged before it is assigned to a nurse to make sure that the members will only be contacted once they are already in the comfort of their homes.
- Audited pre-created referrals and checked any errors. Make sure to add any necessary information before assigning to a nurse to avoid any mistakes.

October 2017 - May 2018
Sykes Asia (Foundever)
Level 1 Technical support
- Assisted customers in Basic troubleshooting of their speakers and/or headphones to avoid replacements and complaints.
- Helped callers in processing replacement for defective items if the basic troubleshooting did not work to make sure complete satisfaction.
- Process orders for parts of speakers when callers would like to fix their speakers on their own.
- Process orders on behalf of customers having trouble processing orders online.
- Provided suggestions on best speakers and/or headphones for the customers before they make a purchase.


May 2016 - July 2017
VXI Global Solutions
Customer Service Representative
- Assisted customers in checking their bills, phone, cable, internet separately and combined to see if there had been any mistakes or anything we could remove from their plan to lower their bill.
- Pitched in sales Offering premium channels or cell phones they could add to their plan as a part of our metric.
- Assisted customers in purchasing Pay per view shows and events when they’re having trouble purchasing from the portal.