Karen Lacerona
Registered Nurse
Pangasinan
Summary
Dedicated, hardworking and energetic registered nurse with 2 years experience in emergency room, and 1 year in community health nursing. I have 7 years US healthcare experience in a call center setting with medical/case management and medical billing experience. Desires to work collaboratively with the interdisciplinary team to provide high-quality patient care and to meet organization's vision and mission for success.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Nurse Medical Information Specialist IV
Conduent Philippines
01.2024 - Current
- Applies expertise in technical areas when reviewing medical bills such as high-level office visits, consultations, surgery, appeals, probate, and legal fees.
- Establishes appropriate final reimbursement outcomes by distinguishing between Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction.
- Communicates and upholds basis for methodology used to accomplish reduction of charges.
- Analyzes and reviews high-level office visits, reports, and record reviews.
- Interprets review guidelines for outpatient claims.
Medical Management Specialist II
Carelon Global Solutions
09.2019 - 07.2023
- Responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers.
- Primary duties may include but are not limited to:
- Gathers clinical information regarding cases and determines appropriate area to refer or assign cases (utilization management, case management).
- Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases.
- Prepares reports and documents all actions. Responds to requests, calls or correspondence within scope.
- Provides general program information to members and providers as requested. May review and assist with cases.
- Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.
- Act as Subject Matter Expert, Quality Analyst and Person of Contact, with Coaching and New-hire training experience.
Medical Billing Specialist
Flowhealth Outsourcing Inc.
09.2018 - 09.2019
- Ensure that payments are made to the correct healthcare provider.
- Ensure accuracy of entries related but not limited to CPT and ICD 10 codes and keep up to date with coding rules.
- Provide timely and relevant solutions to the rejected claims on hand.
- Completely encode patient demographics into the billing software.
- Familiar with the guidelines and regulations set by Medicare, State Programs, HMO and PPO.
- Ensure validation and accuracy of the insurance coverage of the patients.
Medical Billing Representative
Optum Global Solutions
01.2017 - 07.2018
- Gathering support data to ensure invoice accuracy and work through specific billing discrepancies.
- Provide input to policies, systems, methods, and procedures for the effective management and control of the premium billing function. • Monitor outstanding balances and take appropriate actions to ensure clients pay as billed.
- Manage the preparation of invoices and complete reconciliation of billing with accounts receivable.
- Verifying eligibility and benefits through wide variety of website access and calling insurance representative to verify eligibility and claim status and make appropriate actions.
Emergency Room Nurse
Al Nahda Hospital
07.2014 - 07.2016
- Specialize in assessing, intervening, and stabilizing a variety of trauma and illnesses with decisive action and knowledgeable about the general as well as specific health issues.
- Understands triage which a method of prioritizing injuries is based on medical need.
- Identify the medical problem; document history; check for any allergies and current medications; obtain height, weight, body temperature, heart rate and blood pressure.
- Moving patients, taking blood samples, cleaning, and bandaging wounds, administering medications, and maintaining proper supplies of medical equipment.
- Consults and coordinates with health care team members to assess, plan, implement and evaluate patient care plans.
- Prepare and administer (orally, subcutaneously, through IV) and records medications. Reports adverse reactions to medications and treatments in accordance with the policy regarding administration of medications by a licensed registered nurse.
- Educates patients on surgical procedures.
- Monitors and adjusts specialized equipment used on patients and interprets and records electronic displays.
- Provides bedside care for a wide variety of medical patients. Including pre and postsurgery patients
- Initiates patient education plan, as prescribed by physician. Teaches patients and significant others how to manage their illness/injury, by explaining post- treatment care needs.
- Change dressings, insert catheters, start IVs. • Prepares equipment and aide' physician during examination and treatment of patient.
- Responds to life- saving situations based upon nursing standards and protocol.
- Records all care information concisely, accurately, and completely in a timely manner, in appropriate format and on the appropriate forms.
- Performs other position- related duties as assigned, depending on assignment setting.
Staff Nurse
Department Of Health Region 2
01.2013 - 12.2013
- Participated in the implementation of various projects/ programs/ systems and activities related to Maternal, Neonatal, and Child Health and Nutrition (MNCHN) and Pantawid Pamilya Pogram such as:
- a. Maternal Health Services
- 1. Pre- natal care
- 2. Post- natal care
- 3. Family Planning
- b. Child Health Care Services
- 1 . Expanded Program on Immunization
- 2. Nutrition
- 3. Dental Health Programs
- Conducted regular monitoring of various health programs of the municipality.
- Verified/ Validated the compliance to the conditionalities of the Pantawid Pamilya Pilipino Program recipients.
- Conducted Health education and training.
- Assisted in the conduct of disease surveillance.
- Trained and Supervised the Community Health Team
- Made inquiries on the patient's reason for seeking medical help and took their Vital signs.
Education
Master of Arts - Nursing
University of La Salette
Santiago, Province Of Isabela, Philippines 04.2001 -
Bachelor of Science - Nursing
Northeastern College
Santiago, Province Of Isabela, Philippines 04.2001 -
Certification
Registered Nurse
Timeline
Nurse Medical Information Specialist IV
Conduent Philippines
01.2024 - Current
Medical Management Specialist II
Carelon Global Solutions
09.2019 - 07.2023
Medical Billing Specialist
Flowhealth Outsourcing Inc.
09.2018 - 09.2019
Medical Billing Representative
Optum Global Solutions
01.2017 - 07.2018
Emergency Room Nurse
Al Nahda Hospital
07.2014 - 07.2016
Staff Nurse
Department Of Health Region 2
01.2013 - 12.2013
Registered Nurse
04-2011
Master of Arts - Nursing
University of La Salette
04.2001 -
Bachelor of Science - Nursing
Northeastern College
04.2001 -
Similar Profiles
Menchie Gie QuijoyMenchie Gie Quijoy
Customer Service Associate II at Conduent PhilippinesCustomer Service Associate II at Conduent Philippines
Jaed BrondoJaed Brondo
Customer Service Representative at Conduent Business Services PhilippinesCustomer Service Representative at Conduent Business Services Philippines
Lawrence C. LocañasLawrence C. Locañas
HR Solutions Services Associate III at • Conduent Business Services Philippines, Inc.HR Solutions Services Associate III at • Conduent Business Services Philippines, Inc.
Dember Mark OderoDember Mark Odero
Welder at Accel Welding and FabricationWelder at Accel Welding and Fabrication
Monica Carcha AlmoeteMonica Carcha Almoete
Assistant Head Cashier at Puregold BakakengAssistant Head Cashier at Puregold Bakakeng