Joyce Shemelyn Larot
Sr. Customer Service Representative | Medical Service Account Manager
Quezon City,00
Summary
Highly skilled medical virtual assistant with comprehensive knowledge of HIPAA regulations and patient confidentiality protocols. Proficient in electronic health records management, appointment scheduling, and insurance coordination. Dedicated to maintaining the highest standards of data security while providing efficient administrative support to healthcare professionals and ensuring exceptional patient care.
Overview
2
2
years of professional experience
Work History
Service Account Manager
Optum Global Solutions
7 2021 - 5 2024
- As a Medical Service Account Manager with Optum Global, I facilitate seamless healthcare experiences for clients by overseeing the delivery of top-tier medical services.
- Building and maintaining strong relationships with healthcare patients and providers by understanding their needs, objectives, and challenges. This includes regular communication, and ensuring satisfaction with the services provided.
- Proficient in dental terminology and procedures.
- Addressing patients and providers dental and orthodontics concerns.
- Knowledgeable in dental prior authorizations and appeals submission process.
- Capable of providing accurate dental documentation and maintaining streamlined workflows.
- Addressing patients and providers medical insurance concerns, resolving issues, and mitigating risks to maintain high levels of patients and medical provider satisfaction.
- Ensuring compliance with healthcare regulations, privacy laws, and industry standards in all aspects of service delivery. This includes staying updated on relevant regulations and guidelines, implementing compliance processes, and conducting audits as needed.
- Collaborating with internal teams such as operations, sales, and quality assurance to ensure alignment on client needs, service delivery goals, and strategic initiatives.
- Providing clear explanations regarding claims on how it is process and how copays or coinsurance works.
- Assisting patients getting their medications sent to their preferred pharmacy by calling the prescribing physician office to request for the recent or updated prescription for the member's medications.
- Excellent understanding regarding prior authorization and medical appeals process.
- Providing assistance to patients with billing inquiries, payment processing, setting up payment plans, and explaining insurance claims and billing statements in a clear and understandable manner.
- Ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations by safeguarding patient privacy and confidentiality in all interactions and handling of sensitive medical information.
- Adhering to quality standards, performance metrics, and service level agreements (SLAs) established by the BPO company and healthcare clients to ensure high-quality customer service and patient satisfaction.
- Staying updated on changes in healthcare regulations, industry trends, medical terminology, insurance policies, and customer service best practices through ongoing training, professional development, and knowledge-sharing activities.
Travel Consultant
FCTG-Student Universe
1 2020 - 7 2021
- Helping customers plan their flights based on their preferences, budget, and schedule.
- Making and managing reservations for flights, other travel-related services on behalf of customer, ensuring accuracy and timely confirmation.
- Maintained up-to-date knowledge of travel industry trends, regulations and best practices to better serve customers.
- Addressed unforeseen challenges during trips by coordinating alternative arrangements or providing support as needed.
- Resolving any travel-related issues or concerns that may arise before, during, or after the trip, such as flight delays, cancellations, or changes in itinerary, with a focus on providing prompt and effective solutions.
- Identifying opportunities to upsell additional services, upgrades, or travel packages to customers to maximize revenue and enhance their travel experience.
- Ensuring compliance with company policies, industry regulations, and quality standards in all aspects of service delivery, including data privacy, security, and customer satisfaction.
- Staying updated on industry trends, travel regulations, destination information, and new technology tools to enhance skills and knowledge, improve service delivery, and meet customer expectations effectively.
Virtual Assistant/Insurance Biller
WRS (Waiting Room Solutions)
05.2019 - 11.2019
- Managed phone and email correspondence and handled incoming and outgoing mail.
- Upheld the highest standard of confidentiality when handling sensitive information related to clients'' personal or business affairs.
- Verifying patients' insurance coverage and eligibility to determine the extent of their benefits for medical services.
- Using medical coding systems (such as ICD-10 and CPT) to accurately assign diagnostic and procedural codes to patient encounters. This ensures proper billing and reimbursement from insurance companies.
- Knowledgeable in submitting dental claims electronically to different dental and medical insurance providers using the correct ICD-10 and CPT codes based on the services provided to the patient at the facility.
- Knowledgeable with dental and orthodontics medical terminology.
- Preparing and submitting insurance claims electronically to insurance companies for reimbursement of medical services rendered to patients.
- Monitoring the status of insurance claims to ensure timely processing and payment. Following up with insurance companies on outstanding or denied claims, resolving any issues or discrepancies, and appealing denied claims when necessary.
- Generating patient statements, invoices, and bills for services not covered by insurance. Following up with patients on outstanding balances, setting up payment plans, and assisting with billing inquiries or disputes.
- Communicating effectively with healthcare providers, insurance companies, patients, and other members of the healthcare team to coordinate billing activities, resolve issues, and optimize reimbursement.
- Staying updated on changes in healthcare regulations, coding updates, and billing practices through ongoing education and professional development activities to maintain proficiency in the field.
Customer Service Representative
Anthem CA, CO, NV and ACA
12.2017 - 04.2019
- Ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations by safeguarding patient privacy and confidentiality in all interactions and handling of sensitive medical information.
- Responding to inquiries from patients regarding appointments, medical procedures, billing inquiries, insurance coverage, and general healthcare-related questions via phone, email, or chat.
- Assisting patients in scheduling appointments with healthcare providers, including physicians, specialists, diagnostic facilities, and other medical services, ensuring accuracy and efficiency in scheduling processes.
- Verifying patients' insurance coverage, eligibility, and benefits to determine their coverage for medical services, including copays, deductibles, and out-of-pocket expenses.
- Providing assistance to patients with billing inquiries, payment processing, setting up payment plans, and explaining insurance claims and billing statements in a clear and understandable manner.
- Addressing and resolving patient complaints, concerns, or issues related to medical services, billing disputes, appointment scheduling, or other aspects of their healthcare experience in a timely and empathetic manner.
- Documenting all patient interactions, inquiries, and resolutions accurately and thoroughly in the appropriate databases or electronic health records (EHR) systems for future reference and reporting purposes.
- Adhering to quality standards, performance metrics, and service level agreements (SLAs) established by the BPO company and healthcare clients to ensure high-quality customer service and patient satisfaction.
- Staying updated on changes in healthcare regulations, industry trends, medical terminology, insurance policies, and customer service best practices through ongoing training, professional development, and knowledge-sharing activities.
Education
No Degree - Chemistry
Negros Oriental State University
Dumaguete City, Negros Oriental 04.2001 -
Skills
Medical Terminology
Educational Background
Bachelor of Science in Chemistry, 2014 - 2015, Negros oriental State University, Dumaguete City, Negros Oriental, Katipunan National High School, Editor in Chief (Ang Mulawin, School Paper), 1Lt. CAT officer, Brgy. Uno, Katipunan, Zamboanga del Norte, San Vicente Elementary School, Valedictorian, San Vicente Katipunan, Zamboanga del Norte
Personal Information
- Age: 33 years old
- Height: 5'2
- Weight: 45 kls
- Mother's Name: Betty L. Jorca
- Place of Birth: San Vicente, Katipunan, ZN
- Date of Birth: 07/20/90
- Gender: Female
- Marital Status: Single
- Religion: Roman Catholic
Timeline
Virtual Assistant/Insurance Biller
WRS (Waiting Room Solutions)
05.2019 - 11.2019
Customer Service Representative
Anthem CA, CO, NV and ACA
12.2017 - 04.2019
No Degree - Chemistry
Negros Oriental State University
04.2001 -
Service Account Manager
Optum Global Solutions
7 2021 - 5 2024
Travel Consultant
FCTG-Student Universe
1 2020 - 7 2021
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