John Paul Jovi Guda
San Fernando, Pampanga,Philippines
Summary
Highly organized and results-driven Medical Biller with 11 years of experience in billing, coding, and insurance claims processing. Proficient in ICD-10, CPT, and HCPCS coding systems, with a strong understanding of healthcare regulations and insurance procedures. Seeking to bring excellent attention to detail and problem-solving skills to help ensure accurate billing, timely reimbursements, and overall operational efficiency in the revenue cycle management process.
Overview
1
1
Certification
11
11
years of professional experience
Work History
Insurance Billing Specialist
Rheumatology Center of New Jersey (US Client)
10.2023 - Current
- Contact insurance companies regarding claims and eligibility, payment issues, disputes while effectively navigating insurance portals.
- Verify patient insurance eligibility and benefits to ensure accurate billing and coverage information.
- Prepare and submit insurance claims electronically and through paper claim forms.
- Post all electronic Zelis payments and copay programs received through the portal and ensure accurate daily posting of charges.
- Maintain accurate billing records and ensure compliance with established billing and insurance procedures.
- Manage accounts receivable (AR) for office visits, infusions/injections.
- Review and manage patient balances, including processing and coordinating patient refunds.
- Handle inbound and outbound patient calls, providing professional and timely assistance with billing, account, and insurance-related concerns.
- Utilise medical billing and practice management software, including TSI NextGen and Weave.
- Apply appropriate diagnosis and procedure codes using ICD-10 and CPT coding systems.
Billing Resolution Specialist
AVA-REMOTE LLC (US client)
02.2022 - 09.2026
- Processed refund requests, account cancellations, reactivations, and payment disputes through Stripe, ensuring accurate documentation and timely follow-up to maintain account integrity.
- Review and resolve billing discrepancies while maintaining accurate patient account information and payment records.
- Managed inbound and outbound emails through Zoho, addressing billing inquiries, account concerns, and general patient requests to enhance customer satisfaction.
- Collaborate with providers and internal departments to ensure timely resolution of billing and patient-related concerns.
- Coordinated with providers and internal teams via Slack to resolve patient concerns and billing issues efficiently.
- Manage and navigate Electronic Health Record (EHR) systems to review patient accounts, billing information, appointments, and related records.
- Process patient payments by charging cards on file for membership fees, appointment fees, and outstanding account balances.
BIlling Auditor
Revupo!int Company Inc / Pro-Omega Solutions LLC
10.2015 - 09.2023
- Audit health insurance claim such as medical or hospital bills, invoices for medical supplies & equipment, pharmacy, laboratory, radiology and expense bills (copy fee, transportation fee, interpreting services) for correct payment.
- Daily posting of payments.
- Responsible in disputing claims that are denied and rejected from the insurances.
- Responsible in reviewing healthcare laws, claim payments, dispute bills and reimbursement calculations of applicable fee schedule.
- Responsible to review the bills and send report to supervisor for daily errors from Medical coders.
Education
Master of Business Administration - Bachelors of Science in Business Administration Major in Marketing Management
University of the Assumption | 2011-2015
City of San Fernando01-2015
Skills
- Insurance claims
- Revenue cycle
- Patient billing
- Account reconciliation
Certification
- Certificate of HIPAA 2026
Timeline
Insurance Billing Specialist
Rheumatology Center of New Jersey (US Client)
10.2023 - Current
Billing Resolution Specialist
AVA-REMOTE LLC (US client)
02.2022 - 09.2026
BIlling Auditor
Revupo!int Company Inc / Pro-Omega Solutions LLC
10.2015 - 09.2023
Master of Business Administration - Bachelors of Science in Business Administration Major in Marketing Management
University of the Assumption | 2011-2015