Riza Rose V. Rosal
Summary
Successful Client Services Representative with 7years of experience addressing customer requests and concerns. Expert at providing relevant information and options to successfully resolve issues. Upbeat and energetic handling difficult situations through resourcefulness and adaptability.
Overview
7
7
years of professional experience
Work History
Client Service Representative
Microsourcing Philippines Inc.
02.2023 - Current
- Developed and implemented processes for efficient handling of client requests and concerns.
- Analyzed customer feedback to identify trends and recommend improvements in service offerings.
- Maintained accurate records of client interactions using CRM software for effective follow-up actions.
- Led initiatives to optimize workflows, resulting in enhanced productivity within the team environment.
- Handled sensitive client information with discretion, ensuring confidentiality at all times.
Insurance Verification Specialist/AR Billing Specialist
MicroSourcing Philippines Inc.
02.2023 - Current
- Initiate patient calls and schedule routine appointments for sleep studies and procedures.
- Enter all appointments into electronic scheduling system.
- Schedule physician consults and follow up on prescribed orders.
- Review patient files for accuracy and compliance.
- Knowledgeable in medical terminology.
- Experienced in PHI security (HIPAA).
- Proficient in MedDra, WHODrug, Epic, Athena for EMR records.
- Assist in managing clinician schedules daily.
- Facilitate walk-ins to maximize RT appointments and minimize wait times.
- Ensure same-day patient authorizations are completed.
- Process patient payments and copays.
- Scan and download patient data into Brightree system.
- Fax benefit and patient information to doctors' offices.
- Verify patient insurance coverage for services provided by the company.
- Re-verify benefits when necessary.
- Provide patients with information about their coverage.
- Contact patients if insurance is terminated.
- Discuss financing options to fit patient budgets case-by-case.
- Obtain authorizations for requested services and confirm entry into EMR system.
- Manage client inquiries to enhance customer satisfaction and retention.
- Collaborate with teams to streamline service delivery and improve response times.
- Maintain accurate records with attention to client information updates.
Prior Authorization Representative
Genfinity Philippines Inc.
07.2022 - 01.2023
- Obtains authorizations for all requested services
- Confirms that authorizations are received and entered on sales orders and EMR system for all services
- Ensures same day patient authorizations are completed
Claims Processor(Chat Support)
Legato Health Technologies Philippines Inc.
06.2021 - 07.2022
- Company Overview: (Anthem / BCBS)
- Obtains authorizations for all requested services
- Confirms that authorizations are received and entered on sales orders and EMR system for all services
- Ensures same day patient authorizations are completed
- File appeals, dispute, and reconsideration to resolve denials, and complete associated correspondence.
- Responsible for the timely submission of medical claims to insurance companies
- Reviewing and appealing unpaid and denied claims
- Processed claims efficiently, ensuring accurate documentation and adherence to established guidelines.
- Analyzed claim documentation to determine eligibility and validate information for accurate processing.
- Implemented process improvements that reduced claim turnaround times and increased accuracy rates.
Customer Service Experience
Conduent Business Services Inc.
01.2019 - 04.2021
- Medical and Pharmacy Benefits (All Insurances)
- Asst. Team Leader – Completing admin/team lead deliverables and handling overall Team performance.
- Escalation Officer – Taking supervisor/escalated calls and follow up above agent level.
- Subject Matter Expert / Floor Support. – Assisting agents, trainees, and new hire during nesting phase.
- Handles general eligibility and benefit inquiry.
- Answering claims inquiry and Interpreting claim adjudication.
- Providing general reconsideration, dispute, and appeal status information.
- Customer service and technical support representative.
- Experience in using MedDra ,WHODug , Epic and Athena.
- Experience with PHI security (HIPAA).
- Handle call back cases to coordinate with pharmacy to process pending approved medications.
- Identify and prioritize cases that need immediate action and / or escalation.
- Assist pharmacies with updating payers’ billing information.
Technical Support Representative
Teleperformance
01.2018 - 12.2018
- Company Overview: (Telco Seasonal Account)
- Customer service and technical support representative
- Providing general reconsideration, dispute, and appeal status information.
Education
Bachelor - Elementary Education
University of Perpetual Help-Delta System
01.2023
Bachelor - Elementary Education Major in Special Education
The National Teachers College
01.2011
Bachelor of Science - Nursing
Metropolitan Hospital College of Nursing
01.2006
Skills
- Effective communication in both verbal and written forms
- Confident in taking calls and with good comprehension skills
- Able to gather and organize large quantities of data and provide accurate analysis
- Strong organizational skills and the ability to quickly assess and prioritize
- Ability to multitask and manage time effectively
- Experience in reviewing patient charts, medical records, and scanning medical documents
- Knowledge in process and how health insurance works in US such as Medicare and Medicaid
- Knowledge in Revenue Cycle Management
References
For security and privacy purposes, information shall be given upon request.
Timeline
Client Service Representative
Microsourcing Philippines Inc.
02.2023 - Current
Insurance Verification Specialist/AR Billing Specialist
MicroSourcing Philippines Inc.
02.2023 - Current
Prior Authorization Representative
Genfinity Philippines Inc.
07.2022 - 01.2023
Claims Processor(Chat Support)
Legato Health Technologies Philippines Inc.
06.2021 - 07.2022
Customer Service Experience
Conduent Business Services Inc.
01.2019 - 04.2021
Technical Support Representative
Teleperformance
01.2018 - 12.2018
Bachelor - Elementary Education Major in Special Education
The National Teachers College
Bachelor of Science - Nursing
Metropolitan Hospital College of Nursing
Bachelor - Elementary Education
University of Perpetual Help-Delta System
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