DEBTORS CLERK
Mediclinic City Hospital
Total years of experience :7 years, 2 Months
DEBTORS CLERK
September 12, 2012 to present
Mediclinic City Hospital
Dubai Healthcare City
DUTIES AND RESPONSIBILITIES: ➢ Knowledge of Hospital Information System, Laboratory Information System and Radiology Information System.
➢ Demonstrates and applies basic financial knowledge (cashbook, debit and credit notes etc.)
➢ Understands dispatch cycle of insurance handled- Neuron, ADNIC, AETNA, AMITY, Emirates (credit)
➢ Checks thoroughly the claims (IP, OP) . Ensure that approval is valid with patient's signature, doctor's stamp and signature.
➢ Check patient details and keeping appropriate record in HIS.
➢ Basic knowledge of CPT codes, ICD 9 and ICD 10.
➢ Displays knowledge of e-claim process.
➢ Monitors invoices on a daily basis.
2. RECONCILIATION/RESUBMISSION ANALYST- April 2011 to present
DUTIES AND RESPONSIBILITIES: ➢ Re-assess denied claims with both insurance and TPA's policies.
➢ Check if the member is illegible (policy coverage)
➢ Call provider/insurance for clarification of the denied claims.
➢ Sends email to follow-up with insurance/provider regarding the rejected claims.
➢ Check the resubmitted claims if it contains the necessary documents.
➢ Observes professional ethics at all times
➢ Pays the claim if covered and if all the necessary documents needed were provided.
MEDICAL CLAIMS PROCESSOR
August 2, 2009 to August 26, 2012
Neuron Insurance
Dubai, UAE
1. OP/IP CLAIMS PROCESSOR- Aug 2009 to April 2011
DUTIES AND RESPONSIBILITIES: ➢ Responsible for approving or rejecting claims or arranging settlements.
➢ Check both the insurance policies and the claims to make sure that all the information is correct and to determine whether the claims are covered under such policies.
➢ Observes professional ethics during processing of claims.
➢ Ensures quality service to customer at all times.
➢ Arrange financial settlement within policy limits, ensuring that claims lifecycles and budgeting targets are maintained at an agreeable level based on the contract.
➢ Check discharge summary to check patient's course of hospitalization.
➢ Collaborate with doctors especially difficult cases.
➢ Check the results for the procedures/laboratories performed.
➢ Check member's illegibility (policy coverage)
➢ Process eclaims (IP, OP) . Check with HAAD standard tariff.
COMPANY NURSE
September 2008-June 2009
Sunwest Group of Companies
Pasig City, Philippines
DUTIES AND RESPONSIBILITIES
➢ Assessment of patient's complaint
➢ Giving emergency care
➢ Giving emergency drugs
➢ Attending to patient's personal needs
➢ Giving health teachings
➢ Assist patient in transporting to hospital of choice if emergency arises
STAFF NURSE- Medical-Surgical Ward, OB- Gyne Ward
July 2007-September 2008
Eastern Bicol Medical Center
Virac, Catanduanes
DUTIES AND RESPONSIBILITIES: ➢ Receiving the patient
➢ Observing, checking and recording vital signs
➢ Impart health education to patients and their relatives
➢ Accompany patients while transferring from department to department or to other hospitals
➢ Provides an optimum environment for the patient
➢ Provides bedside care to the patient
➢ Assisting the patient for whatever diagnostic or laboratory procedures to be conducted
➢ Allows the patient to verbalize feelings towards hospitalization
June 2003-April 2007 BS Nursing Catanduanes State Colleges Virac, Catanduanes
June 1998-March 2002 Secondary Level Catanduanes State Colleges Laboratory High School Virac, Catanduanes
June 1992-March 1998 Elementary Level Juan M. Alberto Memorial Elementary School Virac, Catanduanes I hereby certify that all above information is true and correct to the best of my knowledge and belief. JUAN PAOLO G. AVILA Applicant's Signature