Experienced medical biller with strong customer service and healthcare background seeking a position to enhance billing abilities and build stronger client relationships. Possessing excellent people-oriented skills, solid foundation in medical terminology, and knowledge in healthcare billing procedures and insurance claim processing. Committed to improving accuracy and efficiency in billing while providing optimal support to healthcare providers.
Hi, I’m
Michelle Ann C. Gonzaga
Summary
Overview
9
years of professional experience
Work History
Vineville Internal Medicine
Medical Biller
07.2023 - 09.2024
Job overview
- Evaluated claim denials and resubmitted claims to insurance companies
- Adjusted credit balances for primary and secondary claims
- Coordinated with insurance companies to inquire about credits and overpayments
- Verified insurance of patients to determine eligibility.
Miramed Philippines Group
Quality Assurance Specialist
05.2022 - 06.2023
Job overview
- Documenting quality assurance activities and creating audit reports
- Collaborating with clients through training if there’s a new process
- Providing client delivery updates on the claims process to improve the team’s quality score
- Coaching agents to assist them in identifying opportunities and providing observations regarding the quality of their work
Miramed Philippines Group
Medical Biller
10.2021 - 04.2022
Job overview
- Adjusting facility claim (UB-04) prior to corrected claims and incorrect claim denials
- Reviewing, submitting claims, and correcting claims electronically to different payers such as Medicare, Medicaid, Veterans Affairs, Worker’s Compensation, PIP, and Commercial Insurance
- Proactively works to ensure claims are reviewed & processed timely
- Coordinating coding denials to the coding team
- Updating secondary claims based on Explanation of Benefits (EOB) received
- Making sure that the claims were billed electronically or sent through mail depending on the payer’s specifications
- Coordinating charges denials to Charge Audit Department
Alorica Philippines
Customer Service Representative/Provider Correspondence
05.2015 - 07.2021
Job overview
- Providing patient’s medical insurance information (e.g
- Benefits, eligibility, enrollment) to providers through inbound calls
- Providing patient Coordination of Benefit (COB) information to the providers
- Reviewing the fee schedules of participating providers
- Providing member’s type of insurance information to providers (EPO, PPO, HMO, POS)
- Reviewing participation status of providers (In Network/Out of Network)
- Determining certain procedures or service’s authorization and referral requirement
- Providing the patient’s accumulated amount towards the Out of Pocket Maximum and Deductible within the calendar year plan
- Providing timely filing information of a specific plan to providers
- Examining the member’s accumulated visits for certain treatments (e.g., chiropractic, physical therapy, speech and occupational therapy, acupuncture) within the calendar year
- Adjusting medical claims (CMS-1500) prior to corrected claims and incorrect claim denials
- Addressing the provider inquiry through a formal letter
- Providing claim status information, claim reprocessing, and escalating claim issues
- Assigning provider appeals for medical review to medical practitioners
Education
Bestlink College of the Philippines
Hotel And Restaurant Services
01.2013
University Overview
The program is designed to provide students with a thorough foundation on the skills required to begin a competitive career in the hotel and restaurant industry.
Skills
- US Medical Insurance
- Excellent Phone Skills
- CMS-1500 (Professional Claims)
- UB-04 (Facility Claims)
- Willing to learn
- Optimistic
- Medical billing
- Insurance claims
References
References
Ronald, Laxamana, Operations Manager, (+63) 925 500 8686, Alorica Philippines
Jeric Watiwat, Immediate Supervisor, (+63) 908 668 6540, Miramed Philippines Group
Timeline
Medical Biller
Vineville Internal Medicine
07.2023 - 09.2024
Quality Assurance Specialist
Miramed Philippines Group
05.2022 - 06.2023
Medical Biller
Miramed Philippines Group
10.2021 - 04.2022
Customer Service Representative/Provider Correspondence
Alorica Philippines
05.2015 - 07.2021
Bestlink College of the Philippines
Hotel And Restaurant Services
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