Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic
Eldie Reyes

Eldie Reyes

Healthcare Medical Virtual Assistant
Naic, Province Of Cavite

Summary

Professional in healthcare administration with strong background in managing authorization processes. 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.

Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows.

Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.

Overview

5
5
years of professional experience

Work History

AR Follow Up /Prior Authorization Specialist

RULA Health
03.2024 - 03.2025
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
  • Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
  • Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.

AR Follow Up Trainer - Hospital Billing

Med-Metrix
09.2022 - 02.2024
  • Delivered high-quality training sessions, leading to increased productivity among team members.
  • Created engaging learning experiences by incorporating real-world examples and case studies into the curriculum.
  • Facilitated post-training evaluations, using feedback gathered to further refine future iterations of course materials and delivery methods.
  • Collaborated with cross-functional teams for seamless integration of new processes and systems.

Healthcare Payment Variance and Denials Specialist

Conifer Solutions
01.2021 - 10.2022
  • Collaborated with cross-functional teams to achieve project goals on time and within budget.
  • Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
  • Followed all company policies and procedures to deliver quality work.
  • Championed the adoption of new software tools that streamlined workflows across multiple departments.

Provider Service Associate

Legato Healthcare
10.2019 - 10.2020
  • Educated providers on guidelines and policies, resulting in increased adherence to industry regulations.
  • Contributed to a higher level of service quality by conducting routine audits of enrolled providers'' credentials and documentation.
  • Managed critical deadlines with consistent completion of detailed monthly contract review for ongoing relationship maintenance with network providers.
  • Improved operational efficiency by identifying areas of improvement in the provider enrollment process and implementing necessary changes.

Education

Bachelor of Science - Information Technology

Cavite State University
Cavite
05.2001 -

Skills

    Strong Verbal Communication

    Data entry

    Insurance procedures

    Medical terminology

    Billing procedures

    CPT Code Proficiency

    Claim research

    Authorizations

    Medical billing procedures

    Claims processing experience

    Prior authorization process

    Medical appeals handling

    Insurance verification

Additional Information

I have expertise in using EHR systems like Meditech, Epic, and Athena, as well as provider portals such as Availity, Aetna, BCBS, Cigna, Optum, UMR, and UHR.

Timeline

AR Follow Up /Prior Authorization Specialist

RULA Health
03.2024 - 03.2025

AR Follow Up Trainer - Hospital Billing

Med-Metrix
09.2022 - 02.2024

Healthcare Payment Variance and Denials Specialist

Conifer Solutions
01.2021 - 10.2022

Provider Service Associate

Legato Healthcare
10.2019 - 10.2020

Bachelor of Science - Information Technology

Cavite State University
05.2001 -
Eldie ReyesHealthcare Medical Virtual Assistant