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John V. — Senior Insurance Verification Specialist from Philippines

John V.

Senior Insurance Verification Specialist

Philippines 3-6 years
Open to offersNew to Platform
Languages
EnglishTagalog
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About

John V. P. is a dedicated Healthcare Administrative Specialist with over five years of experience specializing in Insurance Verification and Prior Authorization for U.S.-based healthcare practices. He has a proven record in verifying patient demographic data, insurance coverage, and pre-certification requirements, along with preparing and processing medical insurance claims. His work includes resolving discrepancies in patient information and billing details with utmost accuracy and timeliness. In his role at FGC+, John efficiently handled insurance details and policy data for four Ambulatory Surgical Centers, ensuring compliance with insurance guidelines. His proficiency extends to various tools like EMR/EHR systems, WebPT, and insurance web portals, where he demonstrated a keen attention to detail and a high level of productivity. Moreover, his tenure at Professional Physical Therapy via Sutherland Global and WellCare Medicare Part D showcases his capability in managing insurance verifications and authorizations while providing superior customer service. John holds a Bachelor's degree from New Era University, emphasizing his solid educational foundation that complements his professional skills.

Experience

  • Insurance Verification & Authorization Specialist

    FGC+ · 2024 — 2026
    Conducted verification of patient demographic data, insurance information, and policy details via insurance web portals and direct interactions with insurance representatives for four Ambulatory Surgical Centers. Secured prior authorizations and pre-certifications for various medical procedures, ensuring adherence to insurance protocols prior to service deliveries. Assisted in preparing and processing medical insurance claims with precise patient information and authorization details, while investigating and addressing discrepancies related to patient and insurance data.
  • Insurance Verifier & Patient Scheduler

    Professional Physical Therapy via Sutherland Global · 2022 — 2024
    Conducted patient demographic verifications and insurance coverage assessments for physical and occupational therapy clients through payer portals and direct communication with carriers. Ensured necessary prior authorizations were obtained before service provision, maintaining compliance with payer guidelines. Engaged in inbound and outbound calls to clarify insurance coverage and resolve any discrepancies while providing exceptional customer service.
  • Grievance Coordinator & Team Lead – WellCare Medicare Part D

    Teleperformance · 2020 — 2022
    Verified insurance benefit details and investigated authorization denials for Medicare Part D members, addressing discrepancies in accordance with regulatory standards. Interacted with insurance carriers and members to clarify coverage information and resolve billing issues, ensuring comprehensive resolutions. Processed documentation and forms in line with payer and HIPAA requirements, while supporting team members on complex verification cases with problem-solving assistance.

Skills & Expertise

Education

  • Bachelor of Evangelical Ministry, Undergraduate
    New Era University · 2015 — 2019

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