Hi, I’m Julius, and I am a Philippine Registered Nurse. For more than five years, I've conducted medical-legal record reviews for personal injury cases (ex. Auto-a----------- claims; slip and fall; food poisoning), Workers' Compensation claims, and other medical-legal matters. I am an expert in reviewing Police reports, Attorney letters, Correspondence, Vehicle photos, and Electronic Medical Records to come up with a concise medical summary and recommendations and address the Adjuster's Comments and questions. I also examine large-volume document evaluations. In compliance with each client's instructions. I write a concise and detailed review/summary of documents and perform an extensive study.
As a dedicated Clinical Denial Clinician at Tenet/Conifer Philippines for approximately three years, I specialize in managing and resolving clinical denials within the healthcare industry. With a strong background in medical coding, billing, and healthcare reimbursement processes, I work closely with healthcare providers, insurance companies, and clinical teams to identify the reasons for claim denials and implement strategic solutions.
My expertise lies in conducting thorough reviews of denied claims, interpreting medical records, and ensuring that the clinical documentation meets the standards required for successful reimbursement. I collaborate with multidisciplinary teams to appeal denied claims, providing evidence-based documentation and addressing discrepancies in the medical necessity and coding criteria.
I am committed to improving the efficiency and accuracy of the revenue cycle process, ensuring that healthcare providers receive the reimbursement they are entitled to. My role is vital in ensuring that all claims are submitted accurately, and I take pride in ensuring compliance with the latest healthcare regulations and payer policies.
Skilled in Emergency Nursing, Medical-Surgical Nursing, Reporting & Analysis, Microsoft Excel, Microsoft Word, and Data Entry. Strong utilization review management and revenue cycle management.
Additional experience:
- I also worked as a Medical Information Center Officer in Etiqa Life & General Assurance Corp. wherein I provided accurate, relevant and timely information on member’s medical insurance coverage based on their Schedule of Benefit. I also received calls from hospitals and clinics for approval of member’s medical availment.
Other skills:
- Excellent typing speed of 40 words per minute.
- Excellent reading comprehension, which I've honed through several years of writing medical reports.
- Familiar with ICD-9 or ICD-10 and CPT coding.
- Completing bill review based on the Clinical Writer’s determination.
Verified
