ANA MARIE PERFECTA A. AGUILA
Revenue Cycle Management Specialist | Medical Billing Specialist
Bacoor, Cavite, Philippines
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PROFESSIONAL SUMMARY
Medical Billing and Revenue Cycle Specialist with more than 3 years of experience supporting U.S. healthcare providers. Experienced in full-cycle medical billing, accounts receivable follow-up, denial management, appeals, payment posting, insurance verification, and prior authorizations. Managed a monthly AR portfolio of approximately $70,000, maintained a 98% clean claim rate, and achieved an 85% denial overturn rate through consistent follow-up and effective appeals. Experienced working with commercial insurance plans, Medicare, Medicaid, workers' compensation, personal injury, and out-of-network claims. Strong knowledge of reimbursement processes, payer guidelines, and revenue cycle operations.
CORE SKILLS
• Revenue Cycle Management (RCM)
• Medical Billing & Coding (ICD-10, CPT, HCPCS)
• Accounts Receivable Follow-Up
• Denial Management & Appeals
• Insurance Verification
• Prior Authorizations
• Payment Posting
• EOB Review & Reconciliation
• AR Aging Management
• Medicare & Medicaid Billing
• Workers' Compensation Claims
• Personal Injury Billing
• Out-of-Network Claims
• Claim Submission & Follow-Up
• HIPAA Compliance
SOFTWARE & TOOLS
DrChrono | Tebra (Kareo) | Practice Fusion | Athelas | SimplePractice | Availity | Microsoft Excel | Microsoft Word | Google Workspace
PROFESSIONAL EXPERIENCE
Senior Medical Billing Specialist
Orthopedic Spine Practice – Los Angeles, California
April 2025 – May 2026
• Managed approximately $70,000 in monthly Accounts Receivable and followed up on outstanding claims to improve collections.
• Processed an average of 200 claims per month while maintaining a 98% clean claim rate.
• Reduced aged AR by 25% through consistent claim follow-up and denial resolution.
• Achieved an estimated 85% denial overturn rate by reviewing denied claims and preparing detailed appeals.
• Submitted and tracked an average of 15 appeals per month for denied and underpaid claims.
• Investigated denials related to authorization issues, medical necessity, coding errors, coordination of benefits, and payer processing errors.
• Posted insurance and patient payments, reviewed EOBs, and reconciled account balances.
• Handled commercial, Medicare, Medicaid, workers' compensation, personal injury, and out-of-network claims.
• Worked closely with providers and clinical staff to obtain documentation needed for claim resolution and reimbursement.
• Reviewed aging reports and prioritized high-value accounts for follow-up.
Insurance Verifier / Medical Biller
Global Health Resource Philippines
March 2024 – January 2025
• Verified patient eligibility, benefits, and coverage details before services were rendered.
• Worked with major payers including Aetna, Cigna, Anthem, UnitedHealthcare, Medicare, Medicaid, and BCBS.
• Obtained prior authorizations for procedures, specialist consultations, and diagnostic services.
• Submitted claims and reviewed payer requirements to reduce billing errors and claim rejections.
• Followed up with insurance companies regarding claim status, authorization requests, and reimbursement issues.
• Educated patients regarding coverage, deductibles, copayments, and financial responsibility.
Customer Service Representative
Service First
October 2020 – March 2022
• Assisted customers with account inquiries and documentation requirements.
• Reviewed applications and supporting documents for accuracy and completeness.
• Coordinated with internal departments to ensure timely processing and customer support.
KEY ACHIEVEMENTS
• Managed over $840,000 in annual Accounts Receivable.
• Maintained a 98% clean claim rate.
• Achieved an 85% denial overturn rate.
• Reduced aged Accounts Receivable by 25%.
• Processed approximately 2,400 claims annually.
• Submitted and managed more than 180 appeals annually.
• Worked with commercial, Medicare, Medicaid, workers' compensation, personal injury, and out-of-network claims.
EDUCATION
Bachelor of Science in Psychology
Cavite State University
2012 – 2016
