Elijah Bermeo
Caloocan City
Summary
Been in the BPO industry for 11 years, 9 years of which are in US healthcare campaigns, primarily in the RCM segment. I have extensive experience when in comes to Medical Billing & Collections, Utilization Management & Prior Auth, Chart Retrieval for Risk Adjustment. I have handled multiple teams and multiple processes, and I am very passionate about people management including coaching sessions and talent development.
Overview
9
9
years of professional experience
Work History
Assistant Manager
GeBBS Healthcare Solutions
03.2024 - Current
- Spearheaded process improvements based on stakeholder feedback, resulting in increased satisfaction and trust in the department
- Supported team leaders to effectively manage their members during peak periods, ensuring timely completion of tasks without compromising on quality standards
- Creates action plans and implement them efficiently
- Prepares decks for business reviews
- Prepares capacity planning and client billing
- Reviewed the medical necessity of a medical procedure prior to submitting it for pre-certification
- Collaborated with the providers about pre-certification requirements to ensure smooth case creation
Supervisor, Utilization Review
Ally Billing Solutions
07.2023 - 02.2024
- Company Overview: (Freelance)
- Mentored junior staff members on best practices within the field of utilization management, fostering a culture of continuous learning and professional growth among team members
- Reviewed medical charts to identify the current condition of the patient and, based on clinical judgment, ensured that ASAM criteria is being met to provide the best care possible
- Collaborated with the treatment team to identify a more suitable level of care for the patient based on the current situation and/or symptoms presented
- Prepared concurrent reviews for patients if they should stay at the current level of care or if they need to step up or down
- Managed the spreadsheet of the patient records from Detox, RTC, PHP, IOP and OP to ensure timely review and follow up on cases
- (Freelance)
Customer Service Supervisor
Concentrix
10.2022 - 06.2023
- Coached team members to deliver hospitable, professional service while adhering to set service models
- Managed escalated calls with diplomacy, successfully deescalating situations while ensuring satisfactory resolutions for both parties involved
- Evaluated individual performance metrics to identify areas of improvement, providing targeted coaching to boost results
Assistant Manager of Operations
Optum
03.2020 - 09.2022
- Reviewed staff performance and coach for opportunities observed
- Collaborated closely with other departments, fostering strong working relationships to expedite resolution of cross-functional issues impacting revenue collection
- Implemented and maintained a comprehensive billing database, ensuring accurate data storage for easy retrieval and analysis
- Oversaw the proper allocation of payments received from various sources, ensuring accurate posting to relevant accounts, and facilitating efficient reconciliations at month end
- Reduced discrepancies in billing reports with thorough review processes and diligent follow-ups on outstanding accounts.
- Collaborated with onshore partners and clients to quickly resolve any issues before they cause revenue delay
Billing Specialist
Optum
07.2016 - 03.2020
- Prepared UB04 and maintained high accuracy by constantly working with interdepartmental such as coding and collections
- Managed and maintained trackers for escalations for proper and timely handling and collaborated with onshore partners to resolve issues
Education
Bachelor of Science - Nursing
De La Salle University
Dasmarinas, Province Of Cavite, Philippines05.2011
Skills
- Leadership
- Problem-solving
- Communication
- Adaptability
- Team motivation
- Staff training and development
- Operations management
- Strategic planning
- Employee performance evaluations
Timeline
Assistant Manager
GeBBS Healthcare Solutions
03.2024 - Current
Supervisor, Utilization Review
Ally Billing Solutions
07.2023 - 02.2024
Customer Service Supervisor
Concentrix
10.2022 - 06.2023
Assistant Manager of Operations
Optum
03.2020 - 09.2022
Billing Specialist
Optum
07.2016 - 03.2020
Bachelor of Science - Nursing
De La Salle University
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