Rexcidel L.
Mid-Level Medical Insurance Verification Specialist
Open to offersNew to PlatformAbout
Rexcidel L. is an experienced Medical Virtual Assistant and EMR Specialist based in Antipolo City with over 5 years in healthcare and insurance verification. In roles at Illume Fertility and Stat Care Pulmonary and Sleep, Rexcidel managed insurance verification, prior authorization processing, and benefits eligibility specifically for fertility, pulmonary, and sleep medicine services. At Accenture supporting Blue Cross Blue Shield, Rexcidel fielded inbound support calls, clarified claims and authorizations, and utilized CRM systems for precise documentation. While at Enbrighten Solutions | Theradynamics, Rexcidel oversaw clinic operations for physical, occupational, and speech therapies, coordinating patient scheduling, claim tracking, and staff training. Across all positions, Rexcidel maintained strict HIPAA compliance and regularly engaged with EMR/EHR systems to enhance operational efficiency in healthcare business domains.
Experience
Insurance Verification Specialist
Stat Care Pulmonary and Sleep · 2023 — 2026Verified insurance eligibility and benefits for services related to pulmonary and sleep medicine. Prepared and submitted prior authorization requests for various diagnostic tests and treatment procedures. Engaged with insurance providers to validate policy requirements, including co-pay and deductible information. Collaborated with clinical and billing teams to facilitate accurate and timely claims processing. Maintained patient insurance data in the EMR system while strictly following confidentiality protocols. Oversaw pending authorizations and addressed any denials or discrepancies in coverage. Educated patients on their insurance coverage and financial responsibilities while ensuring adherence to HIPAA regulations.Insurance Verification Specialist
Illume Fertility · 2024 — 2025Conducted verification of patient insurance eligibility, coverage, and benefits for fertility-related services. Coordinated with insurance companies to confirm policy details, pre-authorizations, and claims processing requirements. Updated and maintained patient records within the EMR system, enhancing billing and care efficiency. Interacted with patients to clarify their insurance status, explain coverage limitations, and inform them of potential out-of-pocket costs. Worked alongside billing and clinical teams to resolve discrepancies and expedite service approvals. Ensured all communications adhered to HIPAA regulations and clinic confidentiality standards.Provider and Member Services Representative
Accenture | Blue Cross Blue Shield · 2022 — 2023Handled inbound calls from members, providers, and healthcare professionals regarding eligibility, benefits, claims, and authorizations. Verified member coverage and clearly communicated details about plan benefits, co-pays, deductibles, and claim statuses. Assisted providers by elucidating prior authorization requirements and supported claim submissions while updating necessary policies. Investigated and resolved billing discrepancies, denials, and appeals following BCBS guidelines. Documented call interactions and resolutions in the CRM system to ensure accurate case management. Collaborated with internal teams to escalate complex issues for timely resolution while maintaining high-quality service standards.Healthcare Operations Specialist
Enbrighten Solutions Inc. | Theradynamics · 2020 — 2022Managed administrative and operational processes for multiple therapy clinics within Theradynamics. Scheduled patient appointments, verified benefits and eligibility, and handled insurance prior authorizations for therapy services. Processed and tracked insurance claims, payments, and collections to assure efficient revenue cycle management. Communicated with insurance providers and patients to resolve coverage issues and billing discrepancies. Partnered with therapists and clinic managers to ensure effective coordination between clinical and billing operations. Monitored service quality and operational efficiency to meet company KPIs and expectations while providing training and support to new team members.Customer Service Representative
Alorica | Amazon (Seasonal Account) · 2019 — 2019Managed administrative tasks for a seasonal account with Amazon, focusing on customer inquiries and resolutions. Handled customer service operations by responding to orders, product information queries, and account issues. Provided essential support during peak seasons, effectively managing high volumes of customer interactions. Resolved customer complaints to ensure satisfaction and retention while maintaining records of interactions for effective follow-up. Worked collaboratively with team members to adapt services according to dynamic demands.
Skills & Expertise
Education
- BS, Medical TechnologyOur Lady of Fatima University
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