GIRLY HOPE B. TIBON

Data Processing Specialist

Harris Resolv Pacmed

06.2022 - 09.2025

Pulled batches of patient superbills, demographics, and payment information from the portal.
Entered patient information into the system and verified insurance eligibility via phone calls and online portals, including Trizetto, Blue Shield, Availity, Noridian, NaviNet, and others.
Entered CPT codes and diagnoses into the system, identified primary diagnosis codes for specific procedure codes, and applied appropriate modifiers in accordance with coding guidelines.
Posted charges and submitted claims to insurance companies for reimbursement.
Handled Trizetto rejection reports and worked claim rejections to ensure timely resubmission and resolution.
Reached out to the point of contact or clinic to obtain necessary information, such as correct procedure codes, updated insurance details, or new insurance coverage.
Timely Task Completion: Complete assigned tasks in a timely manner
Proofreading and Editing: Audit processed data to ensure accuracy and compliance with established standards.
Confidentiality and Compliance: Maintain strict confidentiality of information during data processing task. Adhering to United States of America's HIPAA guidelines and regulations.
Quota Achievement and Reporting: Meet the daily required quota and input all worked accounts in Time Tracker sheet, Batch updates and end-of-day activities in scoreboard..
Cross-Training and Department Support: Crosstrain to serve as backup for other departments and assist w/ addressing concerns from team members. ( Trained in Payment Posting for 4 months and 3 months in AR)