Mark Gamalo
Cebu City,CEBU
Summary
Experienced Medical Virtual Assistant and Healthcare BPO Specialist with over 9 years of experience in U.S. healthcare support. Proven expertise in EHR systems, insurance verification, prior authorizations, and medical claims processing. Strong knowledge of CPT/HCPC codes, ICD-10, and patient financial counseling. Adept at using AdvancedMD, eClinicalWorks, Availity, Salesforce, and Centricity. Seeking a remote position in a patient-focused, compliance-driven healthcare setting.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Patient Financial Counselor
Primary Business Process Outsourcing
Cebu City
01.2023 - Current
- Data Collection: Retrieve data reports from the Electronic Health Record (EHR) for procedures within a specified monthly period.
- Benefits & Eligibility: Verify the patient’s medical insurance for coverage of procedures and record the same on EHR.
- Prior Authorization: Check if prior authorization is required for a CPT code and coordinate with the authorization team to create authorization if a procedure requires.
- Creation of Patient Cost Estimate Form: Generated cost estimate forms detailing CPT codes, patient demographics, charge rates, coverage breakdown, and out-of-pocket estimates.
- Collection Calls: Conducted collection calls and payment follow-ups
- Payment Records: Documented payments and provided reference numbers in the EHR
- Coordination with Surgery Coordinators: Liaised with coordinators, finance partners, and escalated concerns
Senior Customer Service Representative – Health Insurance
Optum Global Solutions
Cebu City
01.2015 - 01.2021
- Benefits and Eligibility: Assists medical providers with the quotation of patient’s insurance benefits and eligibility, such as office visits, procedures, diagnostics, DME, and other services covered under the patient’s medical plan.
- Prior Authorization: Check CPT/HCPC codes to determine if it requires prior authorization. Create an authorization if the provider request and provide the authorization number and timeframe for approval.
- Medical Claims: Check status of submitted medical claims, advise of insurance payments, denials, and rejections. Advise the provider of the rationale and reimbursement policies used in denying a claim.
- Reconsideration and Appeals: Guided medical claims reconsideration and appeal processes.
Education
MAED - Social Studies
Cebu Technological University
Cebu City01.2020
Skills
- EHR Management (AdvancedMD, eClinicalWorks, Centricity)
- Insurance Verification & Eligibility
- CPT/HCPC & ICD-10 Coding
- Prior Authorization Processing
- Medical Claims Denial Management
- Patient Financial Counseling
- Platforms: Salesforce, Availity, Nextech, Onehealthport
- Communication & Critical Thinking
- AdvancedMD, eClinicalWorks, Centricity, Nextech
- Salesforce, Availity, Onehealthport
- Cisco, Elevate, 3cx, Avaya, Rightfax
- Google Workspace, Microsoft 365, MS-DOS
Certification
HIPAA Compliance Training – 2025
Timeline
Patient Financial Counselor
Primary Business Process Outsourcing
01.2023 - Current
Senior Customer Service Representative – Health Insurance
Optum Global Solutions
01.2015 - 01.2021
MAED - Social Studies
Cebu Technological University
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