John V.
Mid-Level Medical Billing and Revenue Cycle Specialist
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John V. is a seasoned Medical Billing & Revenue Cycle Specialist with over five years of dedicated experience in the U.S. healthcare sector. His expertise spans comprehensive claims submission, denial management, and accounts receivable follow-up, with a focused capability in mental health billing. He has adeptly handled claims for major commercial payers such as UnitedHealthcare, Aetna, Cigna, Anthem, and Humana, as well as Medi-Cal. John is proficient in CPT/HCPCS and ICD-10 coding standards, and his skills extend to reviewing EOBs and ERAs and deftly managing denied or underpaid claims. With a strong foundation in HIPAA compliance and familiarity with payer portals like Availity, he has consistently delivered clear, empathetic communication while ensuring data accuracy. His professional journey includes roles at Clear Spring Health, Optum Global Advantage, and NTT DATA, where he has been pivotal in resolving claims discrepancies and enhancing operational workflow. John holds a B.S. in Business Administration from Eulogio "Amang" Rodriguez Institute of Science and Technology. His rich experience, coupled with his technical acumen in leading billing systems, makes him an invaluable asset to any healthcare organization.
Experience
Customer Experience Representative
Clear Spring Health · 2025 — PresentAssist members with billing inquiries and claims questions, clarifying health plan benefits and eligibility. Coordinate with providers and teams to manage complaints and resolve complex billing issues. Utilize EMR/CRM and payer portal tools such as Availity and Uniportal for claim and eligibility verification. Ensure compliance with HIPAA and maintain accurate documentation of all interactions in CRM systems. Manage high call volumes while communicating clearly and empathetically in adherence to U.S. healthcare privacy requirements.Sr. Collections Representative
Optum Global Advantage · 2023 — 2025Oversaw a portfolio of U.S. medical accounts receivable that included mental health claims, addressing unpaid, denied, and underpaid insurance claims until resolution. Engaged directly with major commercial payers like UnitedHealthcare and Aetna/CVS Health, as well as Medi-Cal and Medica Advantage on claim issues. Prepared accurate submissions of corrected claims, reconsiderations, and appeals following payer-specific timelines. Monitored ERAs, EOBs, and correspondence daily to track underpayments and discrepancies. Recorded and reconciled payments and adjustments while maintaining high accuracy, prioritizing A/R aging reports for timely follow-up with insurance companies. Recognized recurring denial patterns to suggest workflow improvements and collaborated with various teams to resolve complex reimbursement challenges.Customer Care Collections Sr. Rep.
NTT DATA · 2021 — 2022Managed assigned medical accounts receivable, focusing on the resolution of unpaid, denied, and underpaid claims for U.S. payers. Processed submissions of corrected claims, reconsiderations, and formal appeals in alignment with payer timelines. Regularly reviewed ERAs and EOBs, ensuring proper reconciliation of payments, adjustments, and recoupments. Maintained comprehensive documentation of communications with payers utilizing the electronic health record system. Collaborated with Billing, Authorization, and Clinical teams to address reimbursement challenges while adhering to HIPAA and payer guidelines.Customer Service Representative
Teleperformance · 2020 — 2021Handled inbound calls from customers, providing accurate resolutions to routine inquiries based on established guidelines and KPIs. Ensured data records were maintained accurately, consistently achieving high customer service standards in line with performance targets.Property Administrator
Equiland Property Management Corp. · 2019 — 2020Managed coordination of property maintenance work orders and supplier/vendor activities, providing inspection reports to senior management.Facilities Administrator
Equiland Property Management Corp. · 2017 — 2019Coordinated vendor performance for facility supplies while ensuring compliance with health and safety regulations.
Skills & Expertise
Education
- Bachelor of Science in Business AdministrationEulogio "Amang" Rodriguez Institute of Science and Technology – Cavite Campus · 2013 — 2017
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