Sarah Ruth Agnes P. Leyson
Imus
Summary
Medical billing and authorization specialist with extensive experience in claims processing, denial management, and revenue cycle management. Demonstrated expertise in ensuring compliance, verifying patient eligibility, and maintaining quality assurance standards. Successfully led teams to enhance productivity and accuracy through targeted training and process improvements. Proficient in client relationship management, data analysis, and performance tracking to drive operational efficiency.
Overview
10
10
years of professional experience
Work History
AR / Medical Billing and Healthcare Representative
Gebbs Healthcare Solutions
04.2016 - 05.2017
- Managed end-to-end medical billing and accounts receivable processes, ensuring timely and accurate claim submissions.
- Submitted claims to insurance providers, ensuring prompt follow-up on unpaid or denied claims to facilitate timely reimbursements.
- Investigated and resolved billing discrepancies and claim denials, enhancing reimbursement accuracy and minimising revenue loss.
- Reviewed and verified patient information, insurance eligibility, and coverage details prior to billing.
- Communicated with insurance companies, patients, and providers to resolve payment issues and clarify billing concerns.
- Performed accounts receivable aging analysis and prioritized high-value or overdue accounts for follow-up.
- Posted payments, adjustments, and reconciled accounts in accordance with company and regulatory standards.
- Maintained accurate and up-to-date patient billing records within electronic medical record (EMR) systems.
- Ensured compliance with healthcare regulations including HIPAA and internal billing policies.
- Collaborated with internal teams (coding, front desk, and clinical staff) to ensure clean claim submission and minimize rejections.
- Generated reports on AR status and collections, providing insights into billing performance and supporting strategic decision-making.
Quality Assurance (QA) Analyst - NDQA
Gebbs Healthcare Solutions
05.2017 - 08.2019
- Conducted quality audits on medical billing, accounts receivable (AR), and claims processing transactions (voice and non-voice) to ensure accuracy and compliance.
- Reviewed claim submissions, payment postings, and denial handling to validate adherence to payer guidelines and billing regulations.
- Monitored compliance with HIPAA, payer policies, and client-specific billing requirements.
- Evaluated agent performance on end-to-end AR workflows, including insurance verification, claims follow-up, and reimbursement processes.
- Provided targeted coaching and feedback to improve accuracy in coding, billing procedures, and denial resolution.
- Identified recurring issues in denials, underpayments, and delayed reimbursements; recommended corrective actions to enhance claim resolution.
- Partnered with operations and training teams to improve clean claim rates and minimise AR aging.
- Performed root cause analysis on billing errors; developed action plans to enhance revenue cycle performance.
- Ensured proper documentation and handling of EOBs (Explanation of Benefits) and payer communications.
Medical Billing Specialist and Authorization
Global Health CareResources
09.2019 - 06.2020
- Verified patient eligibility, coverage, benefits, and authorization requirements prior to claim submission to reduce denials and reimbursement delays.
- Reviewing and submitting professional healthcare claims (CMS-1500) to insurance providers with full accuracy, compliance with payer requirements, and focus on maximizing clean claim rates.
- Identified and resolved claim rejections and denials by reviewing Explanation of Benefits (EOBs) and coordinating with internal teams and insurance payers.
- Reviewed and validated clinical documentation and medical records to ensure accurate coding (CPT) and proper support for medical necessity and billing compliance.
- Managed billing disputes through investigation and documentation review, coordinating with payers and internal teams to resolve claim discrepancies and balance inquiries.
- Prepared and sent medical records to insurance companies for claim processing, audits, pre-authorization, and appeal requirements while ensuring proper handling and confidentiality.
- Processed and coordinated refund requests, including validation of credit balances, review of account history, and ensuring proper authorization and timely reimbursement.
- Generated itemized statements for patients and insurance providers to ensure transparency of charges and support billing inquiries or disputes.
- Handled patient payment arrangements, including structured payment plans, account monitoring, and proper documentation of agreements.
- Updated patient demographics and insurance information in the billing system to ensure accurate claim processing and reduce rejections due to incorrect data.
- Performed accounts receivable (AR) follow-ups to monitor outstanding balances and ensure timely resolution and posting of payments.
Team Leader - Medical Billing
Global Health CareResources
06.2020 - 04.2026
- Supervise and mentor a team of medical billing specialists, ensuring high-quality output, productivity, and adherence to SLAs and client-specific billing requirements.
- Continued active role as a Medical Billing Specialist/SME, handling claims processing, denial management, payment posting, and payer follow-ups to ensure accuracy and compliance with billing guidelines and client standards.
- Monitor daily workflows, assign tasks based on priority and capacity, and ensure timely claim submissions while proactively managing backlogs and workflow bottlenecks.
- Tracked and analysed key performance indicators (KPIs) such as claim turnaround time and denial rates, implementing corrective actions to consistently meet established targets.
- Acted as escalation point for complex billing issues, including claim denials and payer disputes, and resolved issues efficiently using in-depth billing knowledge.
- Conducted training and coaching sessions on claims submission, denial resolution, and billing systems, enhancing team knowledge and accuracy through real-case application and process guidance.
- Collaborate with management to identify process gaps and implement improvements that enhance operational efficiency, reduce error rates, and improve billing turnaround time.
- Ensure continuous compliance with evolving medical billing regulations, payer requirements, and coding standards to maintain audit readiness and operational accuracy.
- Ability to support both operational and client requirements while maintaining hands-on expertise in end-to-end revenue cycle processes.
Education
BS Nursing -
Emilio Aguinaldo College
Manila04-2012
Skills
- Claims processing and denial management
- Revenue cycle management
- Compliance adherence
- Patient eligibility verification
- Team supervision and training
- Client relationship management
- Data analysis and information analysis
- Process improvement and workflow management
- Problem solving and decision making
- Performance tracking and results orientation
- Communication skills and active listening
- Quality assurance and customer service excellence
- Innovative thinking and creative thinking
- Time management and influential leadership
Custom
- Mishael Badal, 09928363450, Senior AR Specialist, Optum
- Kristen Eisanas, 09276394690, Senior Operations Manager, Global Healthcare Resource
- Mary Ann Llames, 09541878231, Operations Manager, Optum
Personal Information
- Height: 5'3"
- Weight: 127 lbs
Timeline
Team Leader - Medical Billing
Global Health CareResources
06.2020 - 04.2026
Medical Billing Specialist and Authorization
Global Health CareResources
09.2019 - 06.2020
Quality Assurance (QA) Analyst - NDQA
Gebbs Healthcare Solutions
05.2017 - 08.2019
AR / Medical Billing and Healthcare Representative
Gebbs Healthcare Solutions
04.2016 - 05.2017
BS Nursing -
Emilio Aguinaldo College