JAEL GOMEZ
Mabalacat City
Summary
Dynamic and strategic thinker recognized for driving organizational success and cultivating strong team dynamics. Possesses a solid understanding of business operations and consistently identifies opportunities for improvement and innovation. A commitment to delivering impactful results enhances overall company performance and fosters a culture of collaboration and excellence. Proven ability to align team objectives with organizational goals, ensuring sustained growth and success.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Denial Management Executive
Ingenious Solutions Inc.
04.2023 - Current
- Clinical Chart Analysis & Compliance: Analyzed and corrected complex pre-coded charts, ensuring accuracy and compliance with clinical documentation standards and NCCI guidelines.
- System Proficiency: Leveraged the EPIC tool for efficient navigation, data extraction, and clinical chart review.
- Payer Expertise: Navigated specific payer portals, including Noridian and Availity, to research payer-specific policies and expedite claim resolution.
- Denial Resolution: Resolved payer denials by strictly adhering to payer/insurance, CPT, and ICD-10 guidelines when applying changes and corrections.
- Appeals & Communication: Communicated directly with payers to verify payment status and prepared and submitted formal Letters of Appeal to aggressively pursue the overturn of complex denials.
Clinical Denial Specialist
Miramed Philippines LLC.
06.2022 - 03.2023
- Clinical Review & Compliance: Analyzed pre-coded charts and clinical documentation, ensuring all claims were strongly supported per medical records.
- System Proficiency: Utilized and efficiently navigated Electronic Health Record (EHR) tools, specifically ECW and EPIC.
- Coding & Denial Resolution: Corrected denials by strictly adhering to payer/insurance, CPT, and ICD-10 guidelines.
Education
Bachelor of Science - Radiologic Technology
Holy Angel University
Angeles City, Philippines05-2019
Skills
- Clinical chart analysis
- Compliance auditing
- Denial resolution
- CPT coding
- Data extraction
- EHR navigation
- Pre-coded chart review
- System utilization
- Policy interpretation
- Radiology
- Payer policy navigation
- ICD-10 coding
Certification
- REGISTERED RADIOLOGIC TECHNOLOGIST
Passed the Licensure Examination for Radiologic Technologists
DECEMBER 2021: Professional Licensure Examination (PRC)
License No. 0023921
- CERTIFIED PROFESSIONAL CODER:
Passed the Certified Professional Coder Certification
NOVEMBER 2022: American Association of Professional Coders(AAPC)
Member ID. 02027383
Timeline
Denial Management Executive
Ingenious Solutions Inc.
04.2023 - Current
Clinical Denial Specialist
Miramed Philippines LLC.
06.2022 - 03.2023
Bachelor of Science - Radiologic Technology
Holy Angel University
References
- Kurt Justin Celestino, Quality Auditor, Celestinojustin31@gmail.com, 09178125032, Ingenious Solutions Inc., Dona Julia Vargas Avenue, Ortigas, Pasig, Philippines, RN, CPC
- Norwegian Cuba, Medical Billing/Coder, Cubanorwegian, 09558669083 , Coronis Health Philippines, Pasig City, Philippines, CPC
Recognition:
Deans Lister A.Y. 2018 – 2019 (1st Semester): BS Radiologic Technology, Holy Angel University, January 25, 2019
Trainings and Internship:
- The Medical City – Clark (SENIOR INTERNSHIP – 1056 hours) Clark Freeport, Mabalacat City October 15 – March 24, 2019
- St. Raphael Foundation and Medical Center, Inc. (JUNIOR INTERNSHIP – 1056 hours) Mabalacat City, Pampanga April 16 – September 16, 2018