Ivy

USRN, CSR,Billing & Collections, Utilization Management

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Overview

Looking for part-time work (4 hours/day)

at $6.00/hour ($528.00/month)

Bachelors degree

Last Active

February 18th, 2025 (yesterday)

Member Since

June 30th, 2023

Profile Description

With over 10 years of experience in healthcare and customer service, I bring a diverse skill set that blends strong clinical expertise with a deep understanding of customer needs. As a Registered Nurse in both the Philippines and the U.S., I have gained hands-on experience across various specialties, including medical ward, paediatric, emergency care, OB-GYN, and surgery. These roles have honed my ability to assess and manage diverse patient cases while collaborating effectively with multidisciplinary teams.

In addition to my clinical background, I have built a strong foundation in customer service, holding roles ranging from Technical Support Representative, Subject Matter Expert (Order Entry and Telco), Intraday Coordinator to Senior Collections Analyst. This experience has sharpened my communication, leadership, and problem-solving skills, all of which I apply in fast-paced healthcare environments.

Most recently, I worked as a Telephone Triage Nurse, providing remote assessments, prescription refills, and care guidance to patients. Currently, as a Utilization Management Nurse, I assess the medical necessity of treatments and procedures, leveraging my knowledge in medical billing and virtual assistance to ensure efficient and high-quality care.

I am eager to apply my clinical, customer service, and problem-solving skills to contribute effectively to your team and further enhance patient care.

Licenses/Certifications:
Registered Nurse PH & US
Medical Biller
Medical Virtual Assistant
HIPAA Certified

Awards:
Top Collections Analyst YTD 2019 and 2021
Consistent Top Employee

Tools:
EPIC
Insinq
4UM
AlertMD
Availity
Five9
Predictal
Microsoft Office
Adobe Photoshop & Illustrator

Top Skills

Professional Services » Management Services » Customer Support Management

Experience: 5 - 10 years

Responding to customer inquiries such as handling inbound and outbound calls from customers who need assistance with billing inquiries, service troubleshooting, account changes, or general information about the product. Address questions or concerns about billing statements, payment options, or charges. Updating customer information, activating new services, assisting customers in service updates or promotions. Escalating complex issues that may require involvement of other departments within the organization and to provide timely resolution. Upselling and cross-selling by promoting products or services to customers based on their needs and preferences.

Customer Support » Insurance » Medical Insurance

Experience: 1 - 2 years

- HIPAA Certified Insurance verification, prior authorization, and appeals. Analysing EOBs and ERAs. Submitting billing data to appropriate insurance providers. Collaborating with the healthcare team to ensure accurate documentation for proper reimbursement. Assist in patient's inquiries with benefits, payment and eligibility. Maintaining accurate and up-to-date patient medical records. Process claims and resolve denials to ensure maximum reimbursement. Monitoring the status of submitted claims and following up on any delays, denials, or rejections to appropriate parties/payers. Conduct duties in a professional and timely manner. Continuously updating skills and knowledge related to medical billing and reimbursement practices. Adhering to healthcare regulations and confidentiality.