Gilbert M.
Mid-Level Healthcare Operations Specialist
Open to offersNew to PlatformAbout
Gilbert S. is an experienced healthcare operations professional and Medical Virtual Assistant with over seven years in the healthcare and medical billing industry. At Ista Personnel Solutions, he served as Team Lead, overseeing daily case management operations, monitoring quality and productivity metrics, and preparing clinical documentation for IP/SNF patient prior authorizations. As a Medical Biller at Hays Primary Care, he managed insurance verification, processed referrals and prior authorizations for medications, and ensured accurate patient records within EMR/EHR systems. His work at Conduent Phils. included processing insurance claims, resolving discrepancies, and acting as a provider representative. Gilbert S. is adept in EMR/EHR systems, clinical documentation, and prescription workflows, and maintains certified HIPAA compliance across remote healthcare settings.
Experience
Team Lead
Ista Personnel Solutions · 2021 — 2025Oversaw daily case management operations to maintain quality and productivity standards. Acted as the escalation point for issues raised by providers, patients, and clients. Conducted training and evaluations for staff aimed at enhancing workflow efficiency and service delivery. Created clinical documentation required for the prior authorization process of IP/SNF patients.Medical Biller
Hays Primary Care · 2025 — 2025Handled the processing of referrals and prior authorizations for medications, ensuring accuracy and compliance. Verified insurance eligibility to avoid delays in approval for medications and services. Maintained and updated patient information within EMR/EHR systems. Collaborated with providers to ensure timely patient care and efficient medication workflows.Claim Specialist
Conduent Phils. · 2017 — 2021Reviewed and analyzed insurance claims to ensure their accuracy, compliance, and completeness. Addressed discrepancies in claims by working with internal teams and insurance partners. Enhanced documentation accuracy while minimizing claim turnaround time. Supported providers by responding to benefits, eligibility, and coverage inquiries. Resolved billing and coverage issues while maintaining a high level of customer satisfaction. Documented interactions according to organizational policies and HIPAA standards.
Skills & Expertise
Education
- Associate Graduate of Information TechnologySaint John Bosco IAS - Makati Branch · 2015 — 2017
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