Kylle Y.
Mid-Level US Healthcare Virtual Assistant
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About
Jhon K. is a seasoned US Healthcare Virtual Assistant and EMR & PBM Specialist based in Cebu City, Philippines, with over four years of experience in supporting physicians, pharmacies, and pharmacy benefit management operations within the U.S. healthcare landscape. He excels at managing physician support tasks, including credentialing documentation, and operates various EMR/EHR systems such as Oracle, Citrix, Zyter, and TruCare. In his role at Optum Global Solutions, he was responsible for handling over 50 prior authorization requests weekly, providing precise and timely submissions to payers. He is also skilled in coordinating with pharmacies and prescribers, resolving claim denials and billing discrepancies, and ensuring HIPAA-compliant data handling. Jhon demonstrated his ability to maintain SLA/KPI targets for case closures and customer satisfaction, while mentoring new hires in PBM and EMR operations. Previously, he served as a Customer Service Representative at FIS Global Solutions, managing banking service inquiries in a high-volume setting.
Experience
Healthcare Customer Service Advocate / Clinical Admin Coordinator
Optum Global Solutions · 2021 — 2026Oversaw the management of more than 50 prior authorization requests on a weekly basis, ensuring timely and accurate submissions to payers. Coordinated efforts with pharmacies and prescribers to avoid therapy gaps, while conducting formulary checks and processing medication refills. Conducted investigations into claim denials and billing issues, preparing appeals and escalating complex cases when necessary. Retrieved and organized medical records, including procedure notes, consult notes, and imaging, for submission to hospitals and insurance providers. Updated patient records accurately and documented clinical interactions in EMR/EHR systems, adhering to HIPAA-compliant workflows. Maintained targets for case closure, first-contact resolution, and customer satisfaction. Provided mentorship to new hires regarding PBM processes, EMR navigation, and HIPAA compliance. Assisted in the physician credentialing process by preparing documentation and monitoring application status.Customer Service Representative – Banking Services
FIS Global Solutions · 2019 — 2021Managed a high volume of incoming calls from U.S. customers inquiring about billing issues, disputes, and fraud investigations. Collaborated with various cross-functional teams to effectively address escalations and maintain accurate CRM case records. Achieved consistency in meeting performance benchmarks for quality, accuracy, and customer satisfaction in a fast-paced environment.
Skills & Expertise
Education
- Bachelor of Science in Customs AdministrationUniversity of Cebu