Summary
Overview
Work History
Education
Skills
Timeline
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Sophia Ysabelle Navarro

Quezon City, Metro Manila

Summary

With over 5 years of experience as a Medical Biller in a contact center healthcare environment, I possess comprehensive expertise in medical billing workflows, insurance claims management, accounts receivable (AR) follow-up, and payer relations. I am proficient in CPT/ICD coding, denial resolution, and electronic health record (EHR) systems, consistently ensuring accurate and timely reimbursement. Backed by a strong history of supporting U.S. healthcare providers, I leverage meticulous attention to detail alongside excellent communication and client service skills to drive operational efficiency and optimize financial outcomes.

Overview

6
6
years of professional experience

Work History

Medical Accounts Receivable Specialist

Harris Global Business Services, Inc.
09.2023 - 05.2025
  • Conducted comprehensive insurance verifications to confirm patient eligibility, benefits coverage, and authorization requirements prior to services.
  • Managed 40+ medical claims efficiently across multiple payers, ensuring compliance with CPT, ICD-10, and HCPCS coding standards.
  • Identified and corrected billing errors, significantly reducing claim rejections and improving first-pass resolution rates.
  • Monitored claim statuses and performed timely follow-ups to expedite reimbursements and minimize aged accounts receivable.
  • Collaborated with providers and insurance representatives to resolve discrepancies and clarify coverage details.
  • Ensured adherence to payer-specific rules and HIPAA compliance standards throughout billing processes.
  • Submitted both electronic and paper claims within payer-specific timely filing limits.
  • Conducted proactive follow-ups on denied or unpaid claims to ensure resolution and secure timely payment.
  • Utilized medical billing software and EHR systems (e.g., EPIC, eClinicalWorks, AthenaHealth) for accurate documentation and claims submission.
  • Delivered consistent improvements in billing cycle efficiency, contributing to higher reimbursement rates and reduced days in A/R.

Medical Claims Specialist

Healthrise Solutions
09.2022 - 09.2023
  • Built and maintained strong relationships with medical providers to facilitate accurate and timely claims processing.
  • Prepared, reviewed, and submitted medical documentation, including insurance forms and claims, in compliance with payer requirements.
  • Retrieved and organized medical records, lab results, and supporting documentation to assist payers in care coordination and claim validation.
  • Submitted claims to insurance carriers, ensuring compliance with billing regulations and payer-specific guidelines.
  • Analyzed complex claims for accuracy, completeness, and validity to determine appropriate settlement amounts.
  • Maintained detailed and up-to-date records of all claim-related activities for audit and reporting purposes.
  • Investigated and resolved billing disputes, discrepancies, and denials in a timely and professional manner.
  • Applied data analysis techniques to identify and resolve inconsistencies in patient or customer account records.
  • Collaborated with cross-functional teams, including billing and finance, to support accurate and timely payment posting.
  • Reconciled patient and insurance accounts to ensure alignment between payments, adjustments, and billed charges.
  • Contributed to improved claims turnaround time by supporting efficient and timely claim processing.

AR Representative I

Conifer Global Business Center
08.2020 - 03.2022
  • Initiated proactive communication with insurance payers to track claim statuses and expedite the resolution of outstanding patient accounts.
  • Followed up on appeals with insurers, ensuring all documentation and corrective actions were submitted promptly and accurately.
  • Prioritized and managed collections of third-party and self-pay receivables to support consistent cash flow.
  • Investigated and resolved complex claim denials, focusing on root causes to improve first-pass resolution rates.
  • Ensured the submission of complete and accurate information to insurance carriers to secure expected reimbursement and minimize delays.
  • Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.

Senior Client Partner

Access Healthcare Services Manila, Inc.
05.2019 - 06.2020
  • Secured pre-certification and prior authorizations on behalf of physicians to ensure timely approval of medical procedures.
  • Recorded and maintained accurate patient information and authorization documentation for compliance and tracking purposes.
  • Collaborated closely with nursing staff to obtain and clarify patient medical information necessary for authorization requests.
  • Evaluated clinical histories and supplied up-to-date medical data to payers to facilitate authorization approvals.
  • Executed assigned tasks including initiation and follow-up of prior authorization requests to maintain workflow efficiency.
  • Managed specialized queues such as Medical and Specialty, Imaging Pre-certification, Worker’s Compensation, and others to streamline authorization processing.
  • Liaised with physicians to address and resolve concerns related to patient medical information impacting authorization outcomes.
  • Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
  • Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.

Education

Bachelor of Science - Medical Technology

Centro Escolar University
Makati City
10.2017

Skills

  • Obtaining Medical Prior-authorization
  • Medical Billing & Coding
  • CPT, ICD-10, and HCPCS Coding
  • Insurance Claims Processing (Commercial & Government)
  • Electronic Health Records (EHR) & Practice Management Systems
  • Accounts Receivable (AR) Follow-Up
  • Denial Management & Appeals
  • Patient Eligibility & Benefits Verification
  • Compliance with HIPAA & Healthcare Regulations
  • Medical Terminology & Healthcare Documentation
  • Workflow Optimization & Process Improvement
  • Familiarity with US Healthcare Payers (Medicare, Medicaid, Private Insurers, Worker's Compensation)
  • Proficient in MS Office, Excel, and Billing Software (eg, AthenaHealth, EPIC, eClinicalWorks)
  • Strong Analytical & Problem-Solving Skills
  • High Attention to Detail & Accuracy

Timeline

Medical Accounts Receivable Specialist

Harris Global Business Services, Inc.
09.2023 - 05.2025

Medical Claims Specialist

Healthrise Solutions
09.2022 - 09.2023

AR Representative I

Conifer Global Business Center
08.2020 - 03.2022

Senior Client Partner

Access Healthcare Services Manila, Inc.
05.2019 - 06.2020

Bachelor of Science - Medical Technology

Centro Escolar University

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Sophia Ysabelle Navarro