Kristina Carbonell
Remote Healthcare Specialist | Billing, Claims & Patient Support
Caloocan,Manila
Summary
Detail-oriented and experienced Healthcare Specialist with over 10 years of expertise in U.S. medical billing, claims processing, appeals, and patient support. Proven track record of managing end-to-end revenue cycle functions, including insurance verification, denial resolution, prior authorizations, and grievance handling. Skilled in navigating various EHR and billing systems with a strong understanding of HIPAA compliance, CPT/ICD-10 coding, and payer guidelines. Known for delivering accurate, efficient, and empathetic service in fast-paced environments. Committed to improving reimbursement outcomes and ensuring exceptional patient experiences.
Overview
14
14
years of professional experience
6
6
years of post-secondary education
2
2
Languages
Work History
Medical Claims & Appeals and Grievance Specialist
Eviden
Taguig City
06.2022 - 10.2024
- Review documents sent by member for clinical and denial arguments for reconsideration.
- Enter and track member inquiries / appeals and written correspondence for timely resolution of appeal or grievance.
- Analyzes Data collected and coordinates with member's treating providers and pertinent department to resolve member's grievance.
- Responsible for reviewing, classifying, researching, investigating, and resolving members complaints (grievances and or appeals).
- Manages all correspondence for specific queues.
Medical Virtual Assistant
Eviden
08.2022 - 01.2023
- Handles RCM process of clinic assigned.
- Patient registration and scheduling.
- Ensure that accurate billing information is entered into billing system.
- Cash posting.
- Billing and Denials Management.
- Follow up on collections and Appeals management.
Medical Claims Processor II
UST Global
07.2021 - 03.2022
- Preparing and submitting billing data and medical claims to insurance companies.
- Ensuring the patient's medical information is accurate and up to date.
- Making sure that CPT and ICD codes are accurate before sending to respective insurance companies.
- Follow up and denials management.
Collections / Billing Analyst for Medicare
Optum Global Solutions Inc.
07.2016 - 12.2020
- Maintained patient information and updated it on system.
- Identify and resolve patient billing and payment issues.
- Manage denial and get in touch with Medicare for denial resolution.
- Verify patient eligibility and claim status with insurance agencies.
- Achieve or exceed quota of 60 claims per day.
Production Analyst
IMS Health Philippines
08.2015 - 07.2016
- Provided support to the production team, ensuring timely completion of projects and adherence to deadlines.
- Conducted regular audits of production processes to ensure compliance with industry standards and best practices.
- Creation of Mechanism of action for product inserts for specific medicines given by the client.
- Research and checking products specifically given by the client.
Medical Analyst / Medical Coder
IMS Health Philippines
01.2013 - 08.2015
- Review and analyze prescription padbooks for coding.
- Codes patient's demographics using internal system.
- Use ICD 10 for coding diagnosis.
- Codes minimum of 3 padbooks/day (100 pages per padbook).
Customer Service Representative
Teletech Philippines
06.2012 - 11.2012
- Manage large amounts of incoming phone calls.
- Identify and assess customers' needs to achieve satisfaction.
- Provide accurate, valid and complete information by using the right methods/tools.
- Handle customer complaints, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution.
Customer Service Representative
Convergys Philippines
02.2011 - 04.2012
- Assisted call-in customers with questions and orders.
- Responded to customer calls and emails to answer questions about products and services.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Maintained a high level of product knowledge to effectively assist customers with accurate information and recommendations.
- Enhanced customer satisfaction by efficiently addressing and resolving their inquiries and concerns over the phone.
Education
B.S - Pharmacy
CENTRO ESCOLAR UNIVERSITY
01.2004 - 01.2010
Skills
- US Medical Claims & Billing
- Appeals & Grievance Resolution
- CPT/ICD-10 Coding
- Denial Management
- Insurance Eligibility & Authorization
- EHR Systems (Salesforce, Practice Fusion, Meditech)
- HIPAA Compliance
- RCM Process Management
- Customer Service & Call Handling
- Data Accuracy & Confidentiality
Websites And Social Links - Linked In
www.linkedin.com/in/kristina-carbonell0528
Timeline
Medical Virtual Assistant
Eviden
08.2022 - 01.2023
Medical Claims & Appeals and Grievance Specialist
Eviden
06.2022 - 10.2024
Medical Claims Processor II
UST Global
07.2021 - 03.2022
Collections / Billing Analyst for Medicare
Optum Global Solutions Inc.
07.2016 - 12.2020
Production Analyst
IMS Health Philippines
08.2015 - 07.2016
Medical Analyst / Medical Coder
IMS Health Philippines
01.2013 - 08.2015
Customer Service Representative
Teletech Philippines
06.2012 - 11.2012
Customer Service Representative
Convergys Philippines
02.2011 - 04.2012
B.S - Pharmacy
CENTRO ESCOLAR UNIVERSITY
01.2004 - 01.2010
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