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    Miracel Magat

    Medical Claims Processor

    MedNet U.A.E

    Location:
    United Arab Emirates - Dubai
    Education:
    Diploma, Medical Coding / Health Information Management
    Experience:
    12 years, 9 months

    Work Experience

    What's your work experience? Your experience is one of the most important sections in a CV.
    List all relevant responsibilities, skills, projects, and achievements against each role.  If you're a fresh grad, you can add any volunteer work or any internship you've done before.
    Add Experience

    Medical Claims Processor

    at MedNet U.A.E
    January 2010
    To July 2012
    United Arab Emirates - Dubai
    MedNet U.A.E.
    HP Building, Internet City, Dubai UAE
    • Medical Claims Processor
    January 2010 up to present
    - Analyzes and processes the insurance claim
    - Assures proper payment in accordance with the benefit plan
    - Enters claims data into system while interpreting coding and understanding medical terminology in relation to the diagnoses and procedures
    - Processes claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
    - Follows adjudication policies and procedures to ensure proper payment of claims.
    - Prepares claim bordereau to be submitted to the designated insurance.
    - Processes E-claims
    - Prepares report for outstanding account payables in E-claims (AUH providers)
    - Prepares daily report for processed E-claims
    - Assigns diagnosis procedures codes using ICD-9-CM official coding guidelines.
    - Assigns procedure codes and diagnostic tests using CPT coding guidelines.

    • Admission Officer (In-Patient/Insurance Department)

    at Canadian Specialist Hospital
    September 2009
    To January 2010
    United Arab Emirates - Dubai
    September 2009 up to January 2010
    - Contacts insurance companies to take verbal approval for every admission (applicable for cardholders)
    - Admits the patient in our system.
    - Escorts admitted patient to their assigned room.
    - Prepares cost estimate for medical management and surgical procedures.
    - Do daily rounding in the hospital for all admissions.
    - Reviews every billing activity sheet in each patient.
    - Prepares billing statement for discharge.
    - Filling and segregating billing to be forwarded to the insurance/s.
    - Finalizing the inpatient claims for billing.
    - Prepares monthly batch of inpatient claims to be forwarded to insurance companies.
    - Explains the admission process, package/s and cost estimate in every admission or surgical
    procedure/s.
    - Coordinates with affiliated HMOs and companies for the issuance of written approval to their members and employees.
    - Gathers all information including medical status of the patient and reports to their designated HMO to get written approval for their hospitalization.
    - Attends to the needs of cardholders, members and their beneficiaries with regards to their medical
    benefits and coverage.
    - Explains the medical coverage in every member or cardholder.
    - Do daily follow ups with the pending approval cases.

    Medical Transcription Senior Editor/MT Leader/QA Officer

    at Medical Billing and Collection Specialists (Phil
    May 2007
    To June 2009
    Philippines
    Medical Billing and Collection Specialists (Phil.)
    3 F Mendoza-Soller Bldg., 51 Arellano St., Dagupan City, Philippines
    • Medical Transcription Senior Editor/MT Leader/QA Officer
    May 2007 up to June 2009
    - Edits and proofreads transcribed files of the MTs before uploading to the clients to ensure quality
    assurance.
    - Prepares and updates specifications and templates in every facility as per client's preference.
    - Checks demographics, contents and correct formats.
    - Reminds MTs both in-house and home based about progressive uploading to avoid late submission of transcribed reports to clients.
    - Helps in transcribing to be able to pass or upload files before TAT (turn-around time)
    - Receives workload from external clients in accordance with systems and procedures agreed upon with such clients.
    - Distributes work assignments to transcription personnel, both in-house and external MTs, in accordance with instructions of the MT Supervisor and policies of the company.
    - Supervises/monitors and assess the performance of personnel assigned in my shift in accordance with performance standards approved by appropriate officers.
    - Coordinates with next shift MT leader for the smooth transition of work.
    - Coordinates with Training Officer and oversee training of personnel assigned to my shift in accordance with policies and programs.
    - Coordinates with IT personnel in the use and maintenance of computer hardware and software needed in the performance of work functions.
    - Performs other assignments related to my functions as may be assigned by superior officers.
    - Submits daily reports about the progress of workload and other reports as may be requested from time to time by immediate head or by other superior officers of the company.

    Medical Transcriptionist

    at ACCUSYS, INC
    November 2006
    To December 2006
    Philippines
    Medical Transcription (On-the-Job Training) (November - December 2006)
    ACCUSYS, INC. (MedScribe Asia), españa Boulevard, Sampaloc Manila

    HMO Coordinator / Billing Officer / System Administrator

    at Nazareth General Hospital -Accounting/Insurance Department
    June 2003
    To February 2006
    Philippines
    Nazareth General Hospital -Accounting/Insurance Department
    Perez Blvd., Dagupan City Pangasinan
    • HMO Coordinator / Billing Officer / System Administrator
    June 2003 - February 2006
    - In charged or tasked with handling all billing and payment transactions for medical consultations and diagnostic procedures.
    - Prepares billing statement for both inpatient and outpatient.
    - Prepares daily income report, reimbursement forms, transmittals, etc.
    - Bills the patient in excess with their medical assistance or coverage.
    - Collects account receivables in all affiliated HMOs and companies.
    - Follows up overdue accounts receivables including promissory notes.
    - Issues/prepares medical certificates, surgical memorandum, OR technique, or medical reports as per
    patient's request.
    - Coordinates with affiliated HMOs and companies for LOA (letter of approval) issuance to their
    members and employees.
    - Attends to the needs of cardholders, members and their beneficiaries with regards to their medical
    benefits and coverage.
    - Gathers all information including medical status of the patient and reports to their designated HMO to get approval for their hospitalization.
    - Explains the medical coverage in every member or cardholder.
    - Responsible in maintaining proper transactions using HIMS, a licensed program used in all
    departments of the hospital.
    - Purchases and monitors office supplies, facility and equipment request and other P.O.

    Officer-in-Charge

    at Disc.net
    June 2003
    To April 2004
    Philippines
    Dagupan (Main) & Mangaldan (Branch)
    • Officer-in-Charge
    June 2003 - April 2004
    - Monitors and purchases equipment and supplies needed for the operation.
    - Checks daily income report.
    - Evaluates personnel's performance including trainees/OJTs for any recommendation.
    - Prepares financial statement for monthly income.
    - Reports problems or any concerns of my subordinates to the president.

    Philhealth Coordinator

    at Quarterly PhilHealth Clerks' Meeting
    January 2002
    To December 2003
    Philippines
    Quarterly PhilHealth Clerks' Meeting (2002 - 2003)
    PhilHealth Regional Office I, Dagupan City

    Phil Health Clerk / HMO Sub-coordinator

    at Nazareth General Hospital
    August 2002
    To June 2003
    Philippines
    • Phil Health Clerk / HMO Sub-coordinator
    August 2002 - June 2003
    - Issues/prepares medical certificates, surgical memorandum, OR technique, or medical reports as per
    patient's request.
    - Assists in processing of SSS and Phil health remittances.
    - Prepares Phil Health claim form for the hospital to collect deducted amount from the patient's
    hospitalization.
    - Codes every diagnosis of admitted patient.
    - Prepares Phil Health reimbursement for direct-claiming patient.
    - Encodes SSS contributions.
    - Secures LOA (letter of approval) or approval number for every admitted cardholder patient.
    - Attends the inquiries of Phil health and cardholder patients.
    - Manages the front desk: answering phone calls, handling inquiries especially HMO cardholder
    members and beneficiaries, directing patients, etc.

    Cashier

    at Nazareth General Hospital
    October 2001
    To August 2002
    Philippines
    • Cashier
    October 2001 - August 2002
    - Primarily responsible for handling and receiving cash, card and check payments of the patients.
    - Prepares and maintains the daily reports for review of the Finance Officer.
    - Prepares and maintains cashier's record book.
    - Ensures that all transactions are correct.
    - Prepares daily report for account receivables and accounts payable of the company.
    - Prepares and ensures proper release of the professional fees of the visiting doctors and resident
    physician.
    GAMEZONE I & II

    Cashier / Data encoder

    at Dagupan (Main) & Mangaldan (Branch
    July 2001
    To October 2001
    Philippines
    • Cashier / Data encoder
    July 2001 - October 2001
    - Receives cash as payment of customer.
    - Prepares daily income report.
    - Performs desktop publishing like encoding and lay-outing.

    Data encoder / Lay-out artist

    at Blue.com.net
    April 2001
    To July 2001
    Philippines
    Blue.com.net
    Arellano Bani, Dagupan City
    • Data encoder / Lay-out artist
    April 2001 - July 2001
    - Encodes and converts word doc to pdf files.
    - Creates/designs invitations in all type of occasion.
    - Makes/designs/lay-outs logo, posters, stickers, etc.
    Disc.net II

    Cashier / Data Encoder

    at Dagupan City
    June 2000
    To March 2001
    Philippines
    Tapuac Dist., Dagupan City, Pangasinan
    • Cashier / Data Encoder
    June 2000 - March 2001
    - Encodes any kinds of files as per costumer's request or demand.
    - Computes daily income and prepares financial report.
    - Assists customers in their concerns with regards to internet, desktop publishing, or network gaming.
    TRAININGS/SEMINARS

    Data Encoder / Lay-out artist

    at Regional Consultation on Medicare Program
    February 2000
    To April 2000
    Philippines
    Regional Consultation on Medicare Program (October 26, 2001) for OFWs and their dependents
    Long Beach Resort & Hotel - Bauang, La Union

    Data Encoder / Lay-out artist (On-the-Job Training) (February - April 2000)
    DISC.NET I (Internet Café)
    Arellano Bani, Dagupan City

    Extra years of experience not listed above:  2 Years, 0 Months   

    Education

    What's your educational background?
    Let employers know more about your education; remember, be clear and concise.

    Diploma, Medical Coding / Health Information Management

    at AHIMA - VirtueLab
    United Arab Emirates - Dubai
    May 2012
    Certified Medical Coder ( 2012 )
    AHIMA Accredited
    Average: 89%

    Diploma, Medical Transcription

    at Virgen Milagrosa University Foundation
    Philippines
    June 2007
    Medical Transcription
    Virgen Milagrosa University Foundation
    San Carlos City, Pangasinan

    Diploma, Computer Science

    at EARN Technology School
    Philippines
    April 2000
    Gold medalist (Computer Science Department-Batch 2000)
    Silver medalist-Computer Excellence (Bitstop Awardee - Batch 2000)

    Languages

    Do you speak more than one language?
    For some jobs, fluency in one or more foreign languages is a plus, so add your language skills to get better results.
    English
    Expert

    Memberships

    Are you a member in any organization or professional club?
    Your professional memberships provide an informative signal about your career aspirations, so add them!
    AHIMA (American Health Information Managerment Association)
    CCA (Certified Coding Associate
    June 2012

    Training And Certifications

    Certified Coding Associate
    Certificate
    Issued in: January 2012 Valid Until: - April 2012