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Allina

Provider Services Supervisor

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Republic of the Philippines, PH
Open to remote
Available on CazVid
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Competencies

Prior Authorization Management

Demonstrated experience with Prior Authorization Management.

Insurance Eligibility & Benefits Verification

Demonstrated experience with Insurance Eligibility & Benefits Verification.

Claims Processing

Demonstrated experience with Claims Processing.

Coordination of Benefits (COB)

Demonstrated experience with Coordination of Benefits (COB).

HIPAA Compliance

Demonstrated experience with HIPAA Compliance.

Education

Bachelor of Science, Business Administration
Bachelor of Science, Business Administration
Polytechnic University of the Philippines – Taguig

Summary

Provider Services Supervisor open to new opportunities

Experience

Provider Services Supervisor

Maxicare Healthcare Corporation

Oversee the processing of outpatient and emergency Letters of Authorization (LOA). Verifying eligibility. Evaluating benefits. Assigning accurate ICD-10 and CPT codes for claim approvals

Optum Global Solutions

Managed high-volume billing operations. Coordinated prior authorizations. Resolved claim denials. Maintained precise audit trails across enterprise CRM systems including Salesforce, FACETS, and ACETS

Customer Advocate Representative

Optum Global Solutions
Jan 2024 - Mar 2025

Managed voice account administrative support covering billing operations, insurance enrollments, account cancellations, and benefit inquiries.. Delivered prior authorizations for members utilizing appropriate CPT and ICD codes tailored to specific diagnoses and service requests.. Coordinated and scheduled dental and vision appointments for members, escalating unresolved claim denials to specialized departments.. Documented high-volume customer interactions within CRM platforms (Salesforce, FACETS, ACETS) to maintain precise audit trails and facilitate timely follow-ups.. Consistently met and exceeded key performance indicators (KPIs) in call quality, resolution rates, and customer satisfaction metrics.

Assistant Manager

Munshi Enterprise Limited (Bangladesh)
Jun 2023 - Nov 2023

Screened and interviewed prospective international candidates across skilled trades, including nursing, carpentry, masonry, and plumbing.. Generated sales leads and built a robust candidate pipeline for international manpower placements.. Executed professional outreach campaigns to prospective global clients to match manpower solutions with organizational needs.. Collaborated with cross-functional recruitment and deployment teams to streamline candidate onboarding and visa/legal documentation.

Regional Account Manager

Optum Global Solutions
Jan 2023 - May 2023

Conducted audits of patient accounts for credit balances and issued accurate refunds to secondary insurance carriers.. Validated primary insurance coverage through Explanation of Benefits (EOBs) and contractual terms to maintain accurate coordination of benefits.. Analyzed and audited UB-04 claim forms to verify billed procedures and ensure overall claim accuracy.. Managed system uploads of critical claim records and UB-04 documentation to support internal audit trails.

Administrative Head

STR Events and Marketing Communication Inc.
Nov 2020 - Nov 2022

Directed billing operations by generating timely Purchase Orders (POs) and Sales Invoices.. Oversaw nationwide logistics and product delivery workflows utilizing third-party logistics services (Lalamove, Grab, Transportify, DHL, J&T Express).. Managed financial administration tasks, including check collections, bank deposits, inventory control, and office procurement.

Procurement Intern

KMC Solution
Dec 2019 - Mar 2020

Maintained database records for vendor contracts and supplier information.. Executed data entry, filing, and processing of standard purchasing documentation.

Skills

Prior Authorization ManagementInsurance Eligibility & Benefits VerificationClaims ProcessingCoordination of Benefits (COB)HIPAA Compliance
Published on CazVid - Sep 2, 2026
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