DAREEN B. ESPIRITU
Lipa City
Summary
Highly motivated and skilled individual with a passion for the healthcare field seeking an opportunity in a dynamic organization. Eager to contribute knowledgeable skills in direct patient care and general medical administrative tasks, including medical claims. Expertise in medical coding, quality auditing, and system rule logic creation for HIS and payer systems. Excel in client relationship management. Graduate of Bachelor of Science in Nursing and a registered nurse (NCLEX-RN). Certified professional coder (CPC). Strong background in hospital billing submission, resubmission, and reconciliation. Wide knowledge of Hospital Information Systems (HIS) and Revenue Cycle Management. Contributed to the development of insurance and medical system rules for improved efficiency. Participated in quality checking through claim validation analysis and provided suggestions for more effective claim processing. Strong team handling skills, including training, KPI management, leave approvals, conducting interviews for applicants, and leading meetings. Ready to make a valuable contribution to your organization.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Staff Nurse
The Paramount Medical Center
03.2025 - Current
- Provides direct patient care
- Collaborating with physicians and other healthcare professionals to assess, plan, and deliver nursing care
- Educating patients and their families about their health conditions
- Performing basic nursing procedures
- Update and maintains relevant patient documentation
- Attends relevant training for skill and knowledge improvement
Lead Consultant & Rules Auditor
SANTECHTURE
06.2022 - Current
- Identify payment trends by different payers for system update
- Provides regulatory update to assure compliant
- Audit current system rules to strengthen claim adjudication
- Contributes on customization of the software’s editing logic coding guidelines
- Creates, Modify and maintains rule engine system (e.g
- Crosswalks, CEED, Coding Guidelines, Medical Billing, insurance policies, etc)
- Handles different region using our technology – UAE, QATAR & KSA
Revenue Integrity – Supervisor
ACCUMED.– PHILIPPINES
09.2021 - 06.2022
- Supervise, Audits & Trains medical coder team to ensure that team complies with proper coding guidelines to guarantee insurance payment
Automation and Claims Engine – Supervisor
NEXtCARE CLAIMS MANAGEMENT
07.2018 - 08.2021
- Responsible to ensure accuracy, consistency, quality and efficiency towards automation of claims processing
- Ensures clinical coding compliance and coding education
- Organizes and distribute work within the centre of excellence
- Acts as the lead expert and trainer for the competency canters across all the Business Units and Operating Entities (Egypt, KSA, Tunisia, Italy, etc.,) regarding clinical coding and maintenance
- Responsible in developing, managing, and maintaining clinical audit databases and assist in explorative data analysis and interpretation of findings
- Assist in development of the coding audit work plan
- Contributes to the development of recommendations aimed at changes to practices and procedures
Insurance Manager
CENTRAL PRIVATE HOSPITAL
04.2018 - 07.2018
- Manage operations and productivity at the front desk and billing department
- Create and modify procedures and documents related to policies
- Assist in claims management
- Identify and analyses risks associated with policies
- Minimize risk of financial loss
- Preside over claims investigations
- Review insurance policies
- Manage insurance data for reports
- Analyses statistical data to identify rejection trends and commit to strategical resubmission process
- Determine premium rates for payer price negotiation
Team Leader –Business Rule
ACCUMED PRACTICE MANAGEMENT, LLC UAE
07.2012 - 04.2018
- Responsible for ensuring that every claim submission will be paid with the help of the rules behind our system that guides the user end to process claims with quality
- Creates, Modifies and maintains the rule engine system that serve as the main guide of the operations team with regards to claim adjudication process and methodology (e.g. Crosswalks, CEED, Coding Guidelines, and Medical Billing) and also insurance policies.
- Assist the QA Department with claim analysis for error verification and solution suggestions
- Review remittance and historical report
- Leads the team and ensures all concerns of the members are met. Responsible for the administrative works that involve the team members, this includes training, KPI, leave approvals and assisting with decision making.
Medical Claim Executive
Neuron, LLC UAE
04.2009 - 07.2012
- Medical Claims Executive (Direct Billing & Reimbursement)
- Client Relationship Officer for top clients
Volunteer Nurse
MARY MEDIATRIX MEDICAL CENTER
11.2008 - 02.2009
- Attend orientation and assist Nursing Coordinator with medical orientation of staff
- Preparation and administration of routine scheduled medications
- Methods of administration include: Oral, IM, SQ, IV, topical, ophthalmic and nebulizer
- Administration of various infusions such as: IV fluids for hydration
- Care, maintenance and use of various types of Central Lines
- Administration of medications in accordance with the standing orders and Health Care Plan, or as ordered by physician
- Care, maintenance and usage of different medical equipment
- Trained to handle patients in different wards, ICU-CCU-PICU, Nursery, NICU, ER and OR
- Attends to all patient’s needs and concerns and carry out doctor’s orders properly
- Endorsed everything that has occurred during shift to the next nurse on duty
- Comply with the standard protocol of the hospital
Volunteer Nurse
Metro Lipa Medical Center
03.2008 - 10.2008
- Providing bedside direct patient care
- Performing basic nursing procedures
- Performs appropriate medication administration regimen
- Aseptically performs wound care if required
- Gives appropriate health teachings for every patient for continuous health care
- Maintaining detailed patient records, including charting observations, treatments, and medication administration
- Working effectively with other healthcare team members like physicians, therapists, and nursing assistants to coordinate patient care
Clinic Nurse
Batangas Dog and Cat Bite Center
02.2007 - 02.2008
- Managed the clinic in general – patient’s concerns, products and supplies inventory and securing total finance matter
- Provides overall assistance to patients who have been accidentally bitten by pet/strayed dogs, cats and rodents
- Accomplished initial interview to gain personal data accurately and conducts nursing head-to-toe assessment of individual clients
- Aseptically performs wound care and performs appropriate injection regimen to patients with injury
- Also provides prophylaxis regimen for patients who are at risk of virus infection
- Gives appropriate health teachings for every patient for continuous health care until session completion
Education
Bachelor of Science -
Bachelor of Science in Nursing
First Asia Institute Of Technology And Humanities04-2006
Medical Coding Certification - Medical Coding
Al Talouk Medical Coding Training
Dubai, UAE12-2017
High School Diploma -
De La Salle Lipa
Lipa City, Philippines06-2001
Skills
- Patient education
- Patient safety
- Direct patient care
- Care planning
- Patient management
- Case management
- EMR / EHR
- Hospital Information System
- Medical Coding
- Claim Billing and Payment
Activities Trainings
- Attended LinkedIn Learning Completed Courses: Six Sigma Foundations; Enhancing Team Innovations; Managing Conflict; Learning from Failure; Managing Time; Building Resilience
- Star of the Year Nominees 2019 and Member of Excellent Team of the Year 2019
- Attended Customer Excellence Training conducted by Allianz CARE CE – 11/01/19
- Training: Triage Nursing at Mary Mediatrix Medical Hospital VLM Hall
- Training: Surgical Site Infection: Facts and Fictions Revealed at Mary Mediatrix Medical Hospital VLM Hall
- Training: Nursing Care of Perioperative Patient
- Training: Nursing Care of Patient with Chest Thoracostomy Tube
Qualifications Certifications
- Graduate of Bachelor of Science in Nursing
- Passed National Council Licensure Examination for Registered Nurses (NCLEX-RN) conducted by National Council of State Boards of Nursing (Registration No. 487079566)
- Passed the Philippine Licensure Examination conducted by the Professional Regulation Commission (License no. 0415517)
- Passed the Certified Professional Coder (CPC) Exam conducted by the AAPC (Membership no. 01571770)
- Medical claim processor (Manual or E-claim) of Direct Billing or Reimbursement, Outpatient or In-Patient.
- Strong background in the process of hospital billing submission, resubmission and reconciliation.
- Wide knowledge of HIS (Hospital Information System) application and Revenue Cycle Management.
- Creates insurance or medical system rule for enhancement of Rule Engine.
- Participate in Quality Checking through claim validation analysis and corrective measure suggestions for more effective claim processing.
- Team handling skill (responsible for training, KPI, leave approvals and interviews for applicants, lead meetings, etc.)
Certification
- Registered Nurse License (RN) - State Board of Nursing.
- Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC).
- Philippine Licensure Examination- Professional Regulation Commission
Timeline
Staff Nurse
The Paramount Medical Center
03.2025 - Current
Lead Consultant & Rules Auditor
SANTECHTURE
06.2022 - Current
Revenue Integrity – Supervisor
ACCUMED.– PHILIPPINES
09.2021 - 06.2022
Automation and Claims Engine – Supervisor
NEXtCARE CLAIMS MANAGEMENT
07.2018 - 08.2021
Insurance Manager
CENTRAL PRIVATE HOSPITAL
04.2018 - 07.2018
Team Leader –Business Rule
ACCUMED PRACTICE MANAGEMENT, LLC UAE
07.2012 - 04.2018
Medical Claim Executive
Neuron, LLC UAE
04.2009 - 07.2012
Volunteer Nurse
MARY MEDIATRIX MEDICAL CENTER
11.2008 - 02.2009
Volunteer Nurse
Metro Lipa Medical Center
03.2008 - 10.2008
Clinic Nurse
Batangas Dog and Cat Bite Center
02.2007 - 02.2008
Bachelor of Science -
Bachelor of Science in Nursing
Medical Coding Certification - Medical Coding
Al Talouk Medical Coding Training
High School Diploma -
De La Salle Lipa
Similar Profiles
HABIBA ANJUMHABIBA ANJUM
Data Entry Operator at Paramount medical centerData Entry Operator at Paramount medical center
Lunide Nord Petit HommeLunide Nord Petit Homme
Non-Emergency Medical Driver at Paramount Non-Emergency Medical TransportationNon-Emergency Medical Driver at Paramount Non-Emergency Medical Transportation
HEATHER PAIVAHEATHER PAIVA
Medical Secretary at Steward Medical Group (SMG) Paramount Primary CareMedical Secretary at Steward Medical Group (SMG) Paramount Primary Care