MA.CORAZON GARCIA COLUMBRES
Freelance Virtual Assistant Health Care Trainer, Freelance Contract Paralegal, Prior Authorization Nurse, Denial Specialist
Calamba City
Summary
Compassionate and detail-oriented healthcare professional with a strong foundation in nursing and a growing career in corporate training for healthcare BPO operations. Experienced in developing and delivering training programs that bridge clinical knowledge with customer service excellence. Known for fostering learner engagement, improving process adherence, and enhancing service quality through interactive facilitation and continuous coaching. Committed to driving operational efficiency while maintaining the highest standards of patient information accuracy and confidentiality.
Overview
8
8
years of professional experience
1
1
Language
Work History
Clinical Subject Matter Expert /Medical Records Analyst
Gebbs Health Care
11.2024 - Current
- Classroom management for every clinical training or up-training class is handled according to the timeline and curriculum. Coordinating clinical training escalations in real-time or as necessary.
- Reviewed and analyzed medical records for accuracy, completeness, and compliance with healthcare guidelines.
- Assisted in prior authorization and denial management processes.
- Coordinated with healthcare providers and insurance companies regarding medical documentation requirements.
- Conducted clinical training and up-training sessions for healthcare associates.
- Supported quality assurance and ensured adherence to client standards and timelines.
Revenue Cycle Management Process Trainer
Greenworks VA Solution
06.2023 - 10.2024
- Classroom management for every training or up-training class is handled according to the timeline and curriculum Coordinating training escalations in real-time or as necessary Supporting any administrative tasks like trainee roster and scheduling.
- Reviewed patient medical records and documentation to support healthcare claims processing.
- Assisted healthcare providers with insurance verification, authorization, and claim documentation.
- Conducted training and coaching sessions for healthcare and medical support staff.
- Managed classroom training, trainee schedules, and administrative tasks.
- Coordinated training escalations and ensured compliance with healthcare account processes.
- (Remote)
Clinical Denial Specialist
Omega Health Care
02.2022 - 05.2023
- Work related to clinical denial management. The individual is responsible for managing claim denials related to authorization, medical record requests, and coordination of benefits.
- Reviews of the claim denial and account, to make determinations of what action to be taken to obtain reimbursement
- Ensure compliance with healthcare regulations, medical codes, and insurance policy requirements
- Maintain accurate and up-to-date records of all denied claims and their resolutions
Clinical Nurse Reviewer
Access Health Care
08.2019 - 02.2022
- Consider medical necessity clinical screenings, determine if medical necessity criteria are met for the patient, communicate with insurance companies for pre-authorization, notify physicians about insurance decisions, and document all reviews
- Analyzing and evaluating patient medical records, charts, and treatment plans to ensure compliance with established clinical guidelines, standards of care, insurance policies, and regulatory requirements.
Human Resource Benefit II/QA Advocate
Conduent
07.2018 - 07.2019
- Assess and ensure quality of work aligns with the outlined expectations.
- Work to understand client expectations and complete daily auditsof team members work in reflection.
- Providing detailed and accurate documentation and data input toteam leadership
Education
Paralegal Certification -
International Academy Manila
01-2021
Bachelor Science - Nursing
University of Perpetual Help System Dalta
01-2010
Pre Dentistry - undefined
Iloilo Doctor's College
01-2006
Skills
Medical Records Review
Prior Authorization
Denial Management
Eligibility and Benefits Verification
Revenue Cycle Management
Clinical Documentation Review
Healthcare Training and Coaching
Quality Assurance
Leadership and Communication
Critical Thinking
Timeline
Clinical Subject Matter Expert /Medical Records Analyst
Gebbs Health Care
11.2024 - Current
Revenue Cycle Management Process Trainer
Greenworks VA Solution
06.2023 - 10.2024
Clinical Denial Specialist
Omega Health Care
02.2022 - 05.2023
Clinical Nurse Reviewer
Access Health Care
08.2019 - 02.2022
Human Resource Benefit II/QA Advocate
Conduent
07.2018 - 07.2019
Bachelor Science - Nursing
University of Perpetual Help System Dalta
Pre Dentistry - undefined
Iloilo Doctor's College
Paralegal Certification -
International Academy Manila