Miracel Magat, Medical Claims Processor

Miracel Magat

Medical Claims Processor

MedNet U.A.E

Location
United Arab Emirates - Dubai
Education
Diploma, Medical Coding / Health Information Management
Experience
13 years, 3 months

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Work Experience

Total years of experience :13 years, 3 months

Medical Claims Processor at MedNet U.A.E
  • United Arab Emirates - Dubai
  • January 2010 to July 2012

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
  • United Arab Emirates - Dubai
  • September 2009 to January 2010

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
  • Philippines
  • May 2007 to June 2009

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
  • Philippines
  • November 2006 to December 2006

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
  • Philippines
  • June 2003 to February 2006

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
  • Philippines
  • June 2003 to April 2004

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
  • Philippines
  • January 2002 to December 2003

Quarterly PhilHealth Clerks' Meeting (2002 - 2003)
PhilHealth Regional Office I, Dagupan City

Phil Health Clerk / HMO Sub-coordinator at Nazareth General Hospital
  • Philippines
  • August 2002 to June 2003

• 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
  • Philippines
  • October 2001 to August 2002

• 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
  • Philippines
  • July 2001 to October 2001

• 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
  • Philippines
  • April 2001 to July 2001

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
  • Philippines
  • June 2000 to March 2001

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
  • Philippines
  • February 2000 to April 2000

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

Education

Diploma, Medical Coding / Health Information Management
  • at AHIMA - VirtueLab
  • May 2012

Certified Medical Coder ( 2012 ) AHIMA Accredited Average: 89%

Diploma, Medical Transcription
  • at Virgen Milagrosa University Foundation
  • June 2007

Medical Transcription Virgen Milagrosa University Foundation San Carlos City, Pangasinan

Diploma, Computer Science
  • at EARN Technology School
  • April 2000

Gold medalist (Computer Science Department-Batch 2000) Silver medalist-Computer Excellence (Bitstop Awardee – Batch 2000)

Specialties & Skills

Microsoft Software
Medical Coding
Medical Transcription
Health Information Management
ACCOUNT RECEIVABLES
ACCOUNTING
ACCOUNTS RECEIVABLES
BENEFITS
BILLING
DIAGNOSIS
OFFICE SUPPLIES
RECEIVABLES

Languages

English
Expert

Memberships

AHIMA (American Health Information Managerment Association)
  • CCA (Certified Coding Associate
  • June 2012

Training and Certifications

Certified Coding Associate (Certificate)
Date Attended:
January 2012
Valid Until:
April 2012