Rodelyn Go, Bsn Rn, Cpc Email & Phone Number

Philippines

• Working as one of the Insurance Supervisors for Receivable Solutions Inc. at Columbia, SC.• Handling a group of Insurance Follow Up Reps who help out with AR solutions.• Lead and supervise a team of insurance follow-up specialists to ensure productivity, accuracy, and adherence to established policies and procedures.• Provide guidance, training, and support to team members to enhance their skills and knowledge.• Oversee the resolution of outstanding insurance claims by monitoring aging reports and implementing strategies to minimize claim denials and delays.• Collaborate with team members to address complex claims issues and escalate when necessary

Cebu, Central Visayas, Philippines

• Managing frontline and back office offshore reps for Receivable Solutions LLC• Oversees the overall operations of the account• Build and maintain strong, long-term relationship between RSi and SOS• Provide proactive approach in maintaining high level standards and addressing challenges for both RSi as our client and the reps• Monitor the teams' metrics, ensuring each rep delivers their desired outcome

Philippines

• Working for Primus Health Network in Florida• Prepares clean claims to third party payers electronically• Transcribe medical charts to medical codes to document patient diagnoses and treatments• Review patient bills and correct any missing or inaccurate information• Interact with physicians and assistants to ensure accuracy• Practice HEDIS coding for payment and measurement of the quality care goals for accreditation

Abu Dhabi, United Arab Emirates

Intake Coordinator/Medical Biller:• Coordinates all daily patient referral and intake operations.• Assists with the implementation of improved work methods and procedures to ensure patients are admitted in accordance with policy• Establishes and maintains positive working relationships with current and potential referral sources• Ensures seamless transition of patients to home care by providing preparation for home care, plan of care initiation, and coordination of care with multiple service providers and agency team• Ensures maximum third party reimbursement through participation in insurance verification and authorization processes• Maintains comprehensive working knowledge of Agency contractual relationships and ensures that patients are admitted according to contract provisions• Assists with weekly posting and maintenance of patient visit schedule under direction of clinical supervisor• Performs liaison services to staff related to operational and clinical documentation compliance• Assists in completion of OASIS for the nursing staff• Recommends strategies or activities intended to improve performance in clinical quality, patient safety, and regulatory compliance of approved plans of care while case is open and at discharge• Identifies diagnosis in which agency would benefit if care map/clinical pathway was developed to effectively utilize resources• Participates in the after-hours on-call schedule as assigned by the Clinical Supervisor• Plotting Nurses and Drivers schedule accordingly• Answering to phone calls after office hours• Quality control of medical equipment through a third party company or medium• Making sure that nurses supplies are distributed accordingly

New Jersey

Meditab's IMS - Account Management Team Lead• Acts as the Account Director, managing a group of Account Managers• Makes sure that Account Managers establish trusting relationship with clients to ensure critical cases are prioritized and desired results are achieved in time• interact closely with the support, implementation, QA/development and other sub-teams to gather, monitor and analyze trending client needs on a regular basis• gain product knowledge essential for client interactions over the period of time• upselling of ancillary products and services• organizing campaigns for clients to engage them in constant learning and participation to ensure continuous business• conduct client satisfaction surveys periodically • coordinate software updates for clients• manage references, maintain a database of references and log frequency of usage• ensure regular updates of the reference list and take necessary steps to generate more references• internal marketing (client relations)• ensure account plans for each client are updated with all current and relevant information • responding to requests from the Account Director, COO and COO in an efficient and timely manner• producing weekly, monthly and quarterly status reports to each client and establishing individual requirements whereby each client receives a bespoke service• conducts random checks of support agent availability• Coordinates with Account Managers in trending client issues and coordinate with Project Managers in conducting Webinars

Cebu, Philippines

• interviews applicants for follow up questions prepared by the underwriters after analyzing applications for health insurance• take part in the preliminary risk assessment process• help in the risk assessment of health insurance applicants through client interaction and interviews• responsible in overseeing the applicants by medical assessment

Sacramento, California Area

Account Manager for Meditab Software / Team Lead of the Accounts Management Team• establish trusting relationship with clients to ensure critical cases are prioritized and desired results are achieved in time• maintaining strong client relationships through regular close contact account management which will include regular meetings, telephone and email communication• interact closely with the support, implementation, QA/development and other sub-teams to gather, monitor and analyze client needs on a regular basis• gain product knowledge essential for client interactions over the period of time• upselling of ancillary products and services• organizing campaigns for clients to engage them in constant learning and participation to ensure continuous business• conduct client satisfaction surveys periodically • coordinate software updates for clients• manage references, maintain a database of references and log frequency of usage• ensure regular updates of the reference list and take necessary steps to generate more references• internal marketing (client relations)• ensure account plans for each client are updated with all current and relevant information • responding to requests from the Account Director, COO and COO in an efficient and timely manner• producing weekly, monthly and quarterly status reports to each client and establishing individual requirements whereby each client receives a bespoke service

Sacramento, California Area

Data Entry• checking member’s eligibility (Medi-cal, Blue Cross, Health Net)• data entering urgent and non-urgent authorizations• adding new members to the data baseRemote UM Coordinator/ Authorization Referral Reviewer • provides overall coordination and support for the remote UM Department• responsible in determining medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination• assists in the control of utilization of resources, pre-occurrence monitoring, intervention and retrospective review• respond to inquiries by providers/site employees relating to standards of care and best practices• checking for possible duplication of authorizations requested• researching and uploading the appropriate guideline for services requested • reviewing notes submitted with the referral/authorization request and summarizing the data to present to the medical director and UM manager for them to review for medical necessity• presenting possible options for the authorization like CCS deferrals, carve outs, etc.• calling the provider’s office to verify on inconsistent data or to request for additional information• receiving calls from provider’s office and health plans for authorization requests

Bachelor Of Science In Nursing

Bachelor Of Science In Information Technology