Ruth E.
Patient Account Specialist
Open to offersNew to PlatformAbout
Ruth E. is a seasoned RCM Specialist based in Caloocan City, Philippines, with over eight years of experience in US healthcare operations. Her expertise lies in eligibility verification and accounts receivable (AR) follow-up, leveraging her skills in managing US healthcare claims. At KMC Solutions, she contributed significantly to client operations for Sightview Software LLC by performing insurance eligibility verification, documenting findings accurately, and maintaining patient records. Ruth also handled AR follow-ups through diligent claim status reviews and assisted in denial resolution by investigating and processing claims efficiently. Previously, at Accenture, she excelled as a Provider Appeal Processor and Quality Auditor, overseeing high-volume insurance claims processing and conducting quality audits to enhance processing accuracy. Her commitment to detail and protocol adherence ensures quality outcomes in fast-paced healthcare environments.
Experience
RCM Specialist / Eligibility Verification & AR Follow-Up
KMC Solutions (Client: Sightview Software LLC) · 2025 — 2026Executed insurance eligibility verification to ensure coverage and benefits before patient appointments. Assessed insurance information for discrepancies impacting claim processing or reimbursement. Maintained organized patient records by documenting eligibility findings accurately. Engaged in Accounts Receivable (AR) follow-ups to check claim status and address unpaid claims. Aided in denial resolution through investigation of unpaid or denied claims to facilitate timely claim processing. Liaised with insurance providers on coverage and claim-related inquiries. Adhered to client guidelines and turnaround times while ensuring accuracy and detail.Provider Appeal Processor / Quality Auditor
Accenture · 2017 — 2025Handled a high volume of insurance claims while aligning with client guidelines and quality standards. Evaluated provider appeals and disputed claims, reviewing supporting documentation and policy guidelines to determine claim outcomes. Conducted quality audits to uncover processing errors and compliance issues. Offered feedback to enhance claim processing accuracy. Resolved claim discrepancies by analyzing supporting documentation. Employed claims management systems to ensure validation of claim information for decision-making. Kept comprehensive records of audit findings, corrections, and updates to processes.
Skills & Expertise
Education
- Bachelor of Science in Business Administration Major in Marketing ManagementUniversity of Caloocan City