Microsoft Word
To obtain a full-time position that will offer a professional working environment and will enable personal and professional growth while meeting the corporation’s goals.
Hi, I’m
Kristina Carbonell
Sr Appeals Specialist For US Healthcare
Caloocan
Summary
Overview
12
years of professional experience
6
years of post-secondary education
Work History
Eviden
Senior Appeals and Grievance Specialist
06.2022 - Current
Job overview
- 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
EVIDEN
Senior Associate KPO
08.2022 - 01.2023
Job overview
- 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.
UST Global
Medical Claims Processor II
07.2021 - 03.2022
Job overview
- 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
Optum Global Solutions Inc.
Collections / Billing Analyst for Medicare
07.2016 - 12.2020
Job overview
- 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
IMS Health Philippines
Production Analyst
08.2015 - 07.2016
Job overview
- 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.
IMS Health Philippines
Medical Analyst / Medical Coder
01.2013 - 08.2015
Job overview
- 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)
Teletech Philipines
Customer Service Representative
06.2012 - 11.2012
Job overview
- 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
Convergys Philippines
Customer Service Representative
2 2011 - 4 2012
Job overview
- 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
CENTRO ESCOLAR UNIVERSITYManila Philipines
B.S Pharmacy
06.2004 - 05.2010
University Overview
Skills
Proficient in relevant computer applications
Knowledge in US Healthcare claims process
Knowledge and application for ICD 10
Knowledge of customer service principles and practices
Good data entry/keyboard skills
Verbal and written communication skills
Stress tolerance
Teamwork
Resilience
Complaint Handling
Dispute Resolution
Policy Knowledge
Teamwork and Collaboration
References
References
- Ms. Cherry Lyn Medalla, Pharmacist, Mercury Drug Corporation, Novaliches Lagro Hilltop Branch, Quezon City, (02) 935-7517 / (02) 937-3261 / (02) 939-4547
- Ms. Recelle Manalastas Team leader, Convergys Philippines, 2nd floor Delta Building, UP-Ayala Technohub, Diliman Quezon City, +639163154503
- Ms. Connie Supnet Dy, Supervisor, APAC – MDI, 8th floor BPI Buendia Center, Makati city, 02-588-5400, +639326520353
- Maria Lourdes Pelaez, Quality Assurance, APAC – MDI, 8th floor BPI Buendia Center, Makati city, 02-588-5400, +639106957514
- Ms. Sirene Joy Bayani Supervisor, Optum Global Solutions, Building O UP Ayala Technohub, Diliman Quezon City, 09399136439
- Ms. Nerissa Valenzuela, Team Lead, UST Global, 6/F Building B One Campus Place, Taguig, 09165057401
- Vogart John Echavia, Immediate Supervisor, 6F Floor One Legrand Tower, McKinley West, Fort Bonifacio, Taguig City, 09274516322
- Ms. Blessie Grace Sotto, Supervisor 6F Floor One Legrand Tower, McKinley West, Fort Bonifacio, Taguig City 08985192024
Timeline
Senior Associate KPO
EVIDEN
08.2022 - 01.2023
Senior Appeals and Grievance Specialist
Eviden
06.2022 - Current
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 Philipines
06.2012 - 11.2012
CENTRO ESCOLAR UNIVERSITY
B.S Pharmacy
06.2004 - 05.2010
Customer Service Representative
Convergys Philippines
2 2011 - 4 2012
Availability
See my work availability
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Available
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tuesday
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friday
saturday
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morning
afternoon
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Work Preference
Work Type
Full TimePart TimeLocation Preference
RemoteHybridImportant To Me
Career advancementWork-life balanceHealthcare benefitsPaid sick leaveWork from home optionPaid time offFlexible work hoursPersonal development programsTeam Building / Company RetreatsQuote
If opportunity does not knock, build a door
Software
Microsoft Powerpoint
Microsoft Excel
Microsoft Outlook
Languages
English
Bilingual or Proficient (C2)
Spanish
Elementary (A2)