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MARIA GRACELYN MASIGLAT, PHRN
Nurse Summarizer/ Prior Authorization Specialist
CALOOCAN
Summary
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
9
9
years of professional experience
Work History
Claims Summarization
Shearwater Health
Taguig (Remote)
06.2025 - 03.2026
- Read through extensive medical charts, accident reports, and legal files to identify key diagnoses, treatments, and expenses.
- Create concise, chronological summaries that highlight relevant information for attorneys, claims adjusters, or insurance underwriters.
- Awards and Recognition Best Nurse for February 2026
Document Reviewer – MR Intake
Shearwater Health
Taguig
11.2023 - 05.2025
- Analyze physician orders and clinical notes to ensure they meet strict Medicare/Medicaid and private payer documentation guidelines.
Clinical Coordinator
Conifer Global Business Center
Taguig
05.2023 - 10.2023
- Creating a positive patient experience by accurately and efficiently handling the day-to-day operations relating to patient scheduling.
Billing-Customer Service Representative II
Cardinal Health International Philippines
Taguig
04.2018 - 04.2023
- Verify patients’ insurance eligibility and verification.
- End to end prior authorization submission and follow ups.
- Coordinate with medical offices to request medical documentation needed for prior authorization submission.
Precertification Coordinator
Access Healthcare Services
Fort Bonifacio Taguig City
12.2016 - 03.2018
- Verify patients’ insurance eligibility and verification.
- Prior authorization submission and follow ups.
Education
Bachelor of Nursing -
Our Lady of Fatima University
Quezon City01.2010
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Mangaldan National High School
Mangaldan, Pangasinan01.2002
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Bari Elementary School
Mangaldan, Pangasinan01.1998
Skills
Deep understanding of Medicare, Medicaid, and commercial payer guidelines
Strong working knowledge of ICD-10, CPT, and HCPCS codes
Proficiency with electronic submission platforms like Availity, NaviNet, or CoverMyMeds
Ability to identify root causes of claim denials and manage the appeals process
Navigating systems such as Epic, Cerner, or Allscripts to pull clinical documentation
Strict adherence to HIPAA guidelines and state/federal healthcare mandates
Software
Timeline
Claims Summarization
Shearwater Health
06.2025 - 03.2026
Document Reviewer – MR Intake
Shearwater Health
11.2023 - 05.2025
Clinical Coordinator
Conifer Global Business Center
05.2023 - 10.2023
Billing-Customer Service Representative II
Cardinal Health International Philippines
04.2018 - 04.2023
Precertification Coordinator
Access Healthcare Services
12.2016 - 03.2018
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Bari Elementary School
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Mangaldan National High School
Bachelor of Nursing -
Our Lady of Fatima University
References
- Vallester, Edna, Team Leader, Enlyte
- Ordonez, Edgar, Performant Team Lead
Awards and Recognition
Claim Summarizer Best Nurse for February 2026