JERRY JAY PONCE
Medical Claims Analyst
Quezon City, Metro Manila,00
Summary
Detail-driven and resourceful Medical Claims Analyst with over a decade of experience navigating the complexities of U.S. healthcare billing. Recognized for efficiently resolving denials, accurately verifying insurance coverage, and expediting claims through the pipeline. Proficient in handling both paper and electronic claims across Medicare, Medicaid, VA, and commercial payers. Demonstrated expertise in utilizing technical tools such as EPIC, Meditech, and SSI, while effectively communicating with providers and insurance representatives to achieve desired outcomes. Committed to upholding compliance standards, optimizing efficiency, and ensuring clean claim outcomes.
Overview
7
7
years of professional experience
Work History
Medical Claims Analyst
Med-Metrix International PH
04.2024 - Current
- Take ownership of full-cycle claims—from intake to resolution—ensuring every detail aligns with payer rules and documentation standards.
- Post insurance payments via ERA and EOB, flagging discrepancies and initiating prompt follow-up where needed.
- Investigate denials using payer portals and direct outreach, then draft and submit strong, well-supported appeals.
- Track high-risk accounts and escalate persistent reimbursement issues to prevent revenue leakage.
- Keep strict confidentiality in line with HIPAA standards while juggling high-volume billing tasks with accuracy.
Customer Care Collections Senior Representative
NTT Data Services
02.2022 - 04.2024
- Handled tough billing questions and collections from U.S. patients and providers with clarity and empathy.
- Broke down complex balances, helped set up payment plans, and guided customers through claims statuses.
- Flagged problematic accounts for escalation and documented every interaction thoroughly to support audit-readiness.
- Supported appeals by gathering missing data and identifying trends in rejections across payers.
- Played a key role in hitting team targets for recovery, call handling, and first-contact resolution.
Customer Service Associate
Concentrix Philippines – Healthfirst NY Account
09.2018 - 02.2022
- Frontline support for plan members and providers—explained benefits, verified eligibility, and tracked claims in real-time.
- Worked closely with the claims team to identify denial causes and ensure timely resolutions.
- Trained in NY-based Medicaid plans and worked daily within HIPAA guidelines and compliance protocols.
- Dealt with high call volumes while maintaining detailed, clear documentation in CRM systems.
- Regularly de-escalated sensitive billing concerns with patience and professionalism.
Education
Bachelor of Science - Computer Science
COLEGIO DE SAN LORENZO
QUEZON CITY 04.2001 -
Skills
Claims Management: CMS-1500, UB-04, EOBs, ERAs, Denials, Appeals, Reconsiderations
Technical And Core Skills
CMS-1500, UB-04, EOBs, ERAs, Denials, Appeals, Reconsiderations, EPIC, Meditech, Mpower, SSI, Medicare, Medicaid, HMO, PPO, VA, Life, Commercial, Payer Portals, Microsoft Excel/Word, Internet Research, HIPAA, Insurance Regulations, Sharp attention to detail, Strong communication, Time management, Team collaboration
Timeline
Medical Claims Analyst
Med-Metrix International PH
04.2024 - Current
Customer Care Collections Senior Representative
NTT Data Services
02.2022 - 04.2024
Customer Service Associate
Concentrix Philippines – Healthfirst NY Account
09.2018 - 02.2022
Bachelor of Science - Computer Science
COLEGIO DE SAN LORENZO
04.2001 -
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