IVY LORRAINE BIGAEL
Summary
I consider myself as motivated, reliable and responsible. I am an industrious person that strives to bring positive impact. Results-driven individual with a solid track record in delivering quality work. Known for excellent communication and teamwork abilities, with a commitment to achieving company goals and delivering exceptional service. Passionate about continuous learning and professional development.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
SourceFit Philippines Inc.
Quezon City
04.2024 - Current
- Reviewed and processed prior authorization requests for medical procedures and medications according to established guidelines.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Processed appeals in a timely manner as per policy guidelines.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
PRIOR AUTHORIZATION SPECIALIST
ATHENAHEALTH
TAGUIG CITY
02.2021 - 02.2024
- Assisted with developing policies and procedures related to prior authorizations.
- Conducted quality assurance audits of prior authorization processes according to established standards.
- Collaborated with insurance companies to clarify coverage details and resolve issues related to prior authorization.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
Physical Therapist
Almario Physio Team
TAGUIG CITY
09.2018 - 11.2020
- Scheduled appointments with patients based on availability and severity of injury.
- Advocated for physical therapy services within the healthcare community and participated in outreach activities to educate the public on the benefits of physical therapy.
- Administered modalities such as electrical stimulation, ultrasound, and heat and cold therapy to reduce pain and inflammation.
- Educated patients on most effective practices for pain alleviation, strengthening and rehabilitation.
- Provided guidance on appropriate lifestyle changes that support optimal health outcomes.
- Educated patients and families on injury prevention, proper body mechanics, and home exercise programs to promote long-term health.
- Identified and properly documented patient goals, evaluated progress and planned reevaluation.
Education
Bachelor of Science - Physical Therapy
Our Lady of Fatima University
01.2018
Skills
- Patient Scheduling
- Patient Assessment and Treatment Planning
- Utilization review experience
- Prior authorization process
- Decision-making
- Adaptability and flexibility
- Documentation
- Insurance Verification
- Medical Terminology
Certification
- HIPAA Training, 04/01/24
- Security Awareness Training, 04/01/24
- HIPAA Training, 01/01/24
- HIPAA Training, 01/01/23
- HIPAA Training, 02/01/22
- HIPAA Training, 02/01/21
- HIPAA Training, 11/01/20
Languages
- Filipino, Native
- English, Fluent
Timeline
Prior Authorization Specialist
SourceFit Philippines Inc.
04.2024 - Current
PRIOR AUTHORIZATION SPECIALIST
ATHENAHEALTH
02.2021 - 02.2024
Physical Therapist
Almario Physio Team
09.2018 - 11.2020
Bachelor of Science - Physical Therapy
Our Lady of Fatima University
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