Virtual Assistant (Medical Biller)

Wellcare Insurance – International US Voice Account Handled member inquiries regarding medication claims, verifying coverage under health plans. Checked benefits and eligibility to ensure accurate and timely information for members. Processed prior authorization requests to support access to necessary treatments. Accepted and processed insurance premium payments with precision and professionalism. Explained complex plan details, including deductibles, initial coverage stage, coverage gap stage, and catastrophic stage limits, in clear and understandable terms. Calculated medication costs under the plan, determining insurance contributions and member responsibility. Managed refunds and reimbursements, ensuring compliance with company policies and member satisfaction. Promoted to Account Supervisor after 6 months, overseeing team performance, coaching representatives, and ensuring service quality until my resignation in July 2024.

KLA - Tencor (Keep Looking Ahead) Provided email and phone support to Field Engineers (FE) and Customer Service Engineers (CSE) across global regions (US, Europe, Japan, Korea, China, Taiwan, Singapore). Created and managed diverse service cases, ensuring accurate documentation and assignment of engineers. Assigned engineers to service cases and updated case details, including escalation/de-escalation and adding CSE lines. Edited, closed, and cancelled service cases as required to maintain workflow efficiency. Processed part orders requested by CSEs and FEs, including cancellations when necessary. Tracked orders using logistics systems and coordinated with logistics teams to resolve delivery delays. Ensured smooth communication between engineers and logistics partners to support timely service delivery.

Medical Biller at Skilled Nursing Facilites Updated inpatient (IP) and insurance claim (IC) notes in AR Proactive to maintain accurate billing records. Reviewed and checked claims in Availity and other insurance portals to verify coverage and resolve discrepancies. Processed insurance claims (IC) in NCS and uploaded billing data to Waystar for reimbursement. Encoded patient diagnoses from SigmaCare and PCC into NCS, ensuring compliance with coding standards. Followed up with insurance providers by phone on denied, pending, or rejected claims to expedite resolution. Corrected and resubmitted rejected claims in Waystar to secure timely payment.