Chelsi P. Judilla
Davao City
Summary
Professional in healthcare administration with strong background in managing authorization processes for Specialty Medications and MRI Authorizations. Also , have experiences insurance verification process and claims. Adept at ensuring compliance, streamlining workflows, and mitigating risks. Consistent track record of fostering team collaboration and achieving results in dynamic environments. Skilled in navigating complex systems, prioritizing tasks, and maintaining high standards of accuracy and efficiency.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Global Medical Virtual Assistants
03.2024 - 03.2025
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
Customer Service Representative
Optum Global Solutions/ United Healthcare
08.2021 - 06.2023
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures.
- Achieved insurance pre-authorizations to enable timely patient procedures.
Customer Service Associate
VXI Global Holdings Incorporated
01.2021 - 06.2021
- Reduced call resolution time by effectively troubleshooting software and hardware problems.
- Conducted comprehensive diagnostic tests to pinpoint underlying causes of reported issues.
- Managed multiple priorities simultaneously while maintaining focus on delivering exceptional customer service.
- Adapted quickly to new technology releases, staying informed on updates that could impact customer experience.
- Provided remote support for customers, guiding them through the resolution process stepbystep.
- Contributed to team success by consistently meeting or exceeding established performance metrics.
- Streamlined support processes by identifying areas for improvement and implementing necessary changes.
Customer Service Associate
Concentrix Inc. (formerly known Convergys Inc.)
03.2017 - 01.2018
- Customer Service Associate
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Contributed to sales growth by upselling products and services based on individual customer requirements.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Addressed customer inquiries to ensure satisfaction and foster positive service experience.
- Improved resolution time with effective problem-solving for customer complaints.
Marketing Operations Officer
Sticky Prints Business Center
11.2014 - 12.2015
- Marketing Operations Officer
- Streamlined marketing processes for improved efficiency and cost savings.
- Increased brand awareness by developing and executing targeted marketing campaigns.
- Mentored junior team members, fostering professional development and enhancing overall team performance.
- Evaluated campaign effectiveness using metrics such as ROI, CTR, and conversion rates to inform future strategies.
- Improved social media presence through consistent posting and audience engagement tactics.
- Launched successful product lines by conducting thorough market research and competitive analysis.
Education
Bachelor of Science - Computer Science
University of Mindanao
Davao City, Province Of Davao Del Sur, PhilippinesBachelor of Science - Financial Management
University of Mindanao
Davao City, Province Of Davao Del Sur, PhilippinesSkills
- Prior authorization process
- Medical terminology
- Medication appeals handling
- MRI Prior Authorization
- Good both in oral and written communication
- Excellent in problem-solving approach
- Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
- Demonstrates effective interpersonal, influence, collaboration and listening skills and drives for results individually and in a team setting
- Pharmacy benefit management
- Prescription coordination
- HIPAA compliance
- CPT coding
- Multitasking ability
- Extensive work experience, possibly in multiple functions
- Ability to work independently possibly in multiple functions
- Ability to work independently
Certification
HIPAA CERTIFIED
- GLOBAL MEDICAL VA
Timeline
Prior Authorization Specialist
Global Medical Virtual Assistants
03.2024 - 03.2025
Customer Service Representative
Optum Global Solutions/ United Healthcare
08.2021 - 06.2023
Customer Service Associate
VXI Global Holdings Incorporated
01.2021 - 06.2021
Customer Service Associate
Concentrix Inc. (formerly known Convergys Inc.)
03.2017 - 01.2018
Marketing Operations Officer
Sticky Prints Business Center
11.2014 - 12.2015
Bachelor of Science - Computer Science
University of Mindanao
Bachelor of Science - Financial Management
University of Mindanao
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