My name is ----------- ----------- ----------- but you can call me Pau. I finished my Bachelor of Science In Computer Science. My first job was in Accenture as a Data Analyst under "healthcare insurance" and I've been in this position for 3years and 2 months and after that my second job was in Med-Metrix as Medical Claims Analyst or A/R Follow up and I've been in this position for 8 months and my last recent job was a healthcare virtual assistant as a Case Manager for 6 months.
As a Data Analyst what we do there is to process the patient healthcare insurance, reviewing patients information and provider information if it's encoded correctly since we have a claim form that can be compared if the patients information or provider information was correct. After determining and reviewing the claim information, we investigate the claim depending on the scenario if it's for medical necessity, authorization and patient's eligibility if the claim will be paid, deny or refer to another department for additional review.
As a Medical Claims Analyst or A/R Follow up this time I'm on provider side that review the patient claim and investigate it, if the claim is correctly denied by the provider and if not we will call the insurance and probe that the claim is payable so we request to reprocess the claim and send a resubmitted claim to the insurance to reprocess the claim since the claim needs to be paid.
And also I have experience as a Healthcare Virtual Assistant as Case Manager, what I do there is End to End Billing, Authorization and Eligibility Check, like Billing the office visit and surgery or resolving EOB Denials. For authorization I check the patient appointment schedule excel to check if the patient has an authorization for the visit and if none I will check the patient insurance portal and get the referral authorization and move it to the patient's chart in athena. And for eligibility check I'll check the patient insurance and go to the patient's insurance portal to determine if the patient was still eligible for the date of visit.
All my experiences are related to healthcare insurance. So if you're looking for a resourceful and reliable person that you can trust to work with, feel free to set up an interview with me.
Best Regards,
