Experienced healthcare professional with a strong background in medical billing, utilization review, and appeals management. Currently serving as a Team Leader at Healthcare Business Solutions, managing a multi-site team across Manila and Cebu, overseeing inpatient and outpatient appeals including medical necessity, authorization denials, level of care, and readmissions. Proven track record in optimizing workflows, improving appeal success rates, and ensuring compliance with payer requirements.
Led key initiatives such as IRF Appeals optimization and the successful launch of Physician Billing Appeals, with full ownership of operations, quality assurance, and process improvement. Skilled in using MCG and InterQual criteria to evaluate cases and support appropriate patient care through effective collaboration with providers and payers.
Strong leadership experience in coaching, performance management, and team development, with a focus on driving accountability and operational excellence. Known for implementing policy enhancements and building KPI tracking systems to improve productivity, quality, and overall team performance.
