Michelle Leyson
Cainta, Province Of Rizal
Summary
Dedicated professional with extensive experience in Revenue Cycle Management (RCM) and call center operations within the health insurance industry. Proven ability to streamline billing, claims processing, and accounts receivable workflows while ensuring compliance with healthcare regulations. Skilled in managing call center teams to deliver exceptional customer service, resolve insurance inquiries, and improve operational efficiency. Adept at leveraging data-driven insights to enhance revenue performance, reduce denials, and improve customer satisfaction. Strong communicator and leader with a focus on process optimization and team development to achieve organizational goals.
Overview
3
3
years of professional experience
Work History
Medical Claim Analyst
Med-Metrix International Ph-I Inc.
05.2023 - Current
- Review and process medical insurance claims for accuracy, completeness, and compliance with coverage guidelines, using ICD-10, CPT, and HCPCS codes.
- Confirm patient insurance coverage and ensure services are covered under the terms of the policy before processing claims.
- Evaluate medical documentation to validate claims, determine payment amounts, and identify discrepancies or issues.
- Investigate reasons for claim denials or underpayments, and prepare documentation for appeals or resubmission, ensuring prompt resolution.
- Maintain clear communication with healthcare providers, insurance agents regarding claim status, denials, and necessary documentation.
- Ensure that all claims comply with industry regulations, including HIPAA, Medicare, Medicaid, and private insurance standards.
Healthcare Customer Service Representative
Concentrix
03.2022 - 05.2023
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
- Facilitated smooth communication between patients, insurance companies, and medical staff for seamless coordination of care.
- Educated customers about billing, payment processing and support policies and procedures.
Education
Bachelor of Science - Business Administation
Batangas State University - ARASOF Campus
Nasugbu, Batangas07-2019
Skills
- Knowledgeable in Epic System
- Critical Thinking
- Insurance claims management
- Attention to detail
- Claims investigation
- Multitasking
Timeline
Medical Claim Analyst
Med-Metrix International Ph-I Inc.
05.2023 - Current
Healthcare Customer Service Representative
Concentrix
03.2022 - 05.2023
Bachelor of Science - Business Administation
Batangas State University - ARASOF Campus
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