Hi, I’m
Camille Kyle Delica
Healthcare Associate/Insurance Verification/Biology
ZAMBOANGA CITY
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
4
years of professional experience
4
years of post-secondary education
Work History
ElemyMiami
Insurance Verification and Authorizations
04.2021 - 08.2023
Job overview
- Self-motivated, with a strong sense of personal responsibility.
- Delivered services to customer locations within specific timeframes.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Calling insurance companies to obtain member’s eligibility and benefits, limitations, and authorization requirements for applied behavioral analysis therapy and pediatric psychiatric services [ABA therapy, psych-diagnostic procedures (psych testing, evaluations, assessments), psychotherapy], being conducted in several places of services depending on the patient’s treatment plan that include home setting, school/ daycare setting, community setting, and telehealth
- Cross-checking accumulations through portals for out-of-pocket max and deductibles
- Checking portals for Medicaid clients (portals used: TMHP, FLMMS, GAMMIS, Availity, NaviNet, UMR portal, Waystar)
- Submits authorization requirements to payers via email, faxes
- Follow ups authorization requests statuses to insurance companies via calls, emails
- Coordinating with other departments - Clinical Operations Team, Credentialing Team, Family Admissions Team and RCM Department to relay clarity of benefits obtained for clients
- Training and assisting newly-hired VOB specialist/s
- Putting benefit and insurance details in Salesforce
- Adhering HIPAA & PHI guidelines
Optum Global SolutionsCebu City
Provider Service Advocate or CSR
08.2019 - 10.2020
Job overview
- Efficiently navigating multiple system and tools
- Researching complex issues across multiple databases and works with support resources to resolve customer issues
- Answering inbound calls from representatives from provider’s office, facilities/hospitals with inquiries with patient’s health insurance
- Following HIPAA guidelines and adheres company rules
- Assisting provider’s staff in providing necessary instructions with regards to the clinical requirements for authorizations and pre-determinations
- Provides recommendations and appropriate course of action to resolve issues such as escalating authorizations by reaching out to case managers and also claim denials wherein reaching out to third party reviewers, and doing extensive research on claim denials
- Assisting providers navigating UnitedHealth Group websites
Education
Western Mindanao State UniversityZamboanga City, Philippines
Bachelor of Science from Biology
06.2015 - 03.2019
Skills
Understanding of insurance details
Quality Assurance and Verification
Insurance coverage verification
Schedule Management
Background in Asana, Zendesk, Salesforce, EHR
Research and due diligence
Administrative support
Timeline
Insurance Verification and Authorizations
Elemy
04.2021 - 08.2023
Provider Service Advocate or CSR
Optum Global Solutions
08.2019 - 10.2020
Western Mindanao State University
Bachelor of Science from Biology
06.2015 - 03.2019