Summary

Overview

Work History

Skills

Work Availability

Interests

Timeline

Mark Chester Labay

Medical Billing & Insurance Verification Specialist

Mandaue City

Summary

Detail-oriented Medical Billing and Insurance Verification Specialist with 8+ years supporting outpatient and specialty practices in remote settings. Professional, organized, and calm under pressure; known for resourceful, independent problem solving and clear communication. Broad revenue-cycle expertise—charge entry, benefits and eligibility verification, ICD-10 and CPT/HCPCS validation, claim submission, clearinghouse edit resolution, denial management and appeals, payment posting, and A/R follow-up. Skilled at navigating commercial and government payer portals to fix rejections, resolve underpayments, and close documentation gaps so claims get paid right the first time. Consistently maintains HIPAA-compliant, audit-ready records while improving accuracy, turnaround, and resolution rates in high-volume workflows. Brings an analytical mindset and a dependable, get-it-done approach to working with providers, coders, and payers.

Overview

years of professional experience

Work History

Remote Medical Biller

Premier Medical Billing

02.2022 - 01.2026

Submitted primary, secondary, and tertiary claims; resolved clearinghouse rejections.
Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
Worked claim denials and A/R follow-ups through EOB review, corrected claims, and appeals.
Posted payments and adjustments; reconciled deposits and resolved zero-pay issues.
Maintained HIPAA-compliant, audit-ready documentation in a remote setting.
Communicated with insurance providers to resolve denied claims and resubmitted.
Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
Reviewed patient diagnosis codes to verify accuracy and completeness.
Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
Achieved significant reduction in outstanding accounts receivables by implementing rigorous follow-up procedures with insurers and patients.
Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Filed and updated patient information and medical records.
Collected payments and applied to patient accounts.
Ensured timely payments from insurance providers through submission of accurate and complete claims.
Verified insurance of patients to determine eligibility.

Insurance Verification Specialist

Optum Specialty Pharmacy

09.2017 - 12.2021

Verified medical and pharmacy benefits and eligibility.
Initiated and tracked prior authorizations with providers and payers.
Validated prescriptions and coding (HCPCS, ICD-10) to prevent delays.
Researched rejections and denials and supported appeals.
Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Updated patient records with accurate, current insurance policy information.
Posted payments to accounts and maintained records.
Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
Monitored refill timelines to prevent therapy gaps and ensure medication continuity
Stayed aligned with company policies and payer guidelines by regularly reviewing updates and implementing changes in daily workflows
Demonstrated proficiency in navigating multiple payer portals to verify benefits, track authorizations, and review claim status
Reviewed internal code libraries and payer references to stay current on ICD-10 and HCPCS code updates or changes
Ensured the rendering and prescribing providers were affiliated with the payer and that Optum was in-network prior to processing first fill or refill
Reviewed benefit details and calculated patient responsibility, including coinsurance, deductibles, and out-of-pocket costs
Identified denied or delayed claims related to specialty medications and submitted detailed email escalations to the onshore team for denial review and resolution

Administrative Assistant

Department of Education

05.2015 - 07.2017

Coordinated onboarding and maintained accurate employee records.
Processed payroll-related requests and confidential documentation.
Organized personnel files for audit readiness.
Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
Promoted a positive work environment through effective communication skills and fostering professional relationships among colleagues.
Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
Ensured accurate record-keeping with diligent data entry and database management for vital company information.
Coordinated office supply inventory management, proactively ordering necessary items before depletion to avoid workflow disruptions.
Assisted with human resources tasks such as updating employee files or submitting time-off requests per company policy guidelines.
Maintained inventory of office supplies and placed orders.
Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.

Customer Service Representative

Panasiatic Solution Inc.

02.2012 - 04.2015

Handled customer inquiries and account transactions accurately.
Resolved customer issues through root-cause analysis.
Maintained quality and productivity standards.
Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Assisted customers in navigating company website and placing online orders, improving overall user experience.
Contributed to sales growth by upselling products and services based on individual customer requirements.
Exceeded performance metrics consistently, earning recognition as a top performer within the team.
Resolved escalated customer issues, restoring confidence in company's commitment to service excellence.
Addressed customer inquiries to ensure satisfaction and foster positive service experience.

Skills

EMR/EHRs: Tebra, TherapyAppointment, Athenahealth,Prompt, HomeStateHealth

Payer Portals: Availity, UHC, Aetna, Cigna, BCBS, Oxford, Empire, Molina, Central California Alliance (CCAH), Nivano, La Salle, Country Care, UMR, Golden Rule, Sierra, HAMP, Medicare, Medicaid

Pharmacy Tools: CoverMyMeds (CMM), Copay Accumulator, Clinical Pharmacy Systems

Records management

CPT knowledge

Customer service

Data entry

Accounts receivable management

Claims processing

Claim submission

Claims review

Patient billing

Insurance claims

Excellent communication

Problem-solving abilities

Time management

Reimbursements

Medicare and medicaid process

Electronic health record software

Insurance verification

Account reconciliation

ICD-10 coding

CMS-1500 billing forms

Denial management

Billing and collection procedures

Medical transcription

Payment posting

Billing systems

Computer literacy

Work Availability

monday

tuesday

wednesday

thursday

friday

saturday

sunday

morning

afternoon

evening

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