JANE PANGILINAN PANGAN
AJMAN,UNITED ARAB EMERATES
Summary
Dynamic, seeking challenging opportunities in a reputed concern, where I can utilize my experience and skills and be an asset to the organization in any given challenge.
Self-motivated with experience in the teaching and Administration sector. Excellent negotiation and Communication skills. Persuasive in dealing with management in the peer group and co-workers. Hardworking and Honest. Willing to take on additional responsibilities in a fast-paced and challenging environment. Ability to work cross-functionally with minimal supervision. Good at the time and can cope with stress management
Efficient Insurance Coordinator with 4 years of experience in property and casualty insurance industry. Highly organized and adept at managing large volumes of claims from initial submission through to resolution and payout. Accomplished in meeting production-driven goals.
Overview
7
7
years of professional experience
10
10
years of post-secondary education
Work history
Insurance Manager
Ajman medical Center LLC
Ajman, United Arab Emirates
05.2018 - Current
- Coordinating with insurance companies for obtaining information on new policies and their coverage
- Assisting invoicing department in insurance processing and billing
- To liaise with patients regarding their eligibility and entitlements
- To maintain and update records related to pre-approvals and reconciliation
- To coordinate and co-operate with colleagues of the same department and other related departments for smooth running of Insurance operations
- Preapproval and Precertification for claims requiring approval
- Monitoring and follow up on prior authorization for outpatient/inpatient services
- Contacting the physician/nurse for further clarification to make the claim eligible for preapproval
- Prepares reports of daily activity as requested for management and assists management in monthly reports as requested
- Handle Auditing Process
- Arrange required documents and papers and check with coders in order to assist the external Auditors
- Train Front office, Receptionist and Nurses and keep them updated about Insurance details
- Process insurance and pre-treatment estimates and call patients when received
- Retrieve missing insurance information
- Acts as a liaison between the organization, its insurance provider and agents, claimants, and policy holders regarding the status and eligibility for coverage for all relevant claims
- Contact insurance companies as required to monitor claims status, pursue and dispute claim denials and seek all methods to resolve open claims which positively impact the adjudication process and minimize rejection.
Insurance coordinator
AJMAN MEDICAL CENTER LLC
Ajman, Ajman
05.2017 - 07.2021
- Processed accurate and timely insurance applications, updates, and claims.
- Obtained data such as patient, insurance ID, insurance provider, and medical codes to properly file insurance claims.
- Informed customers of changes to products, services, and laws affecting current accounts.
- Reviewed accounts receivable reports, insurance contracts, and weekly and monthly financial reports.
- Prepared insurance claims for submission to clearing houses or insurance companies.
- Obtained prior authorization and pre-certification for outpatient procedures.
- Verified insurance and communicated coverage to staff and patients.
Education
Medical Coder - MEDICAL
07.2020 - 04.2021
Bachelor Degree - EDUCATION
06.1987 - 04.1992
Secondary -
06.1983 - 06.1987
Skills
- Proficient in CPT, ICD-10-CM & HCPCS coding conventions
- OP & IP Approvals (Riayati & eClaims)
- Proficient in Coding Software (Codify by AAPC)
- Familiar with anatomy, and medical terminology
- Common Insurance Guidelines Knowledge
- Dental & physiotherapy approvals
- Strong knowledge of Medical terminology, Anatomy, Physiology, Pathology, and diagnosis
- Able to review patient medical record
- Medicare, Medicaid, Insurance regulations
- Data entry and Management Knowledge of relevant software systems such as MS Office, particularly Excel
- Interpersonal skills, team player, hardworking, and excellent communication skills
- Insurance claims and denial processes
- Very confident and thorough in executing the assigned jobs systematically
- Medical billing and coding
Languages
English
Fluent
References
References available upon request.
Timeline
Filipino Institute - Medical Coder, MEDICAL
07.2020 - 04.2021
Insurance Manager - Ajman medical Center LLC
05.2018 - Current
Insurance coordinator - AJMAN MEDICAL CENTER LLC
05.2017 - 07.2021
University of the Assumption - Bachelor Degree, EDUCATION
06.1987 - 04.1992
St. Joseph’s Academy School - Secondary,
06.1983 - 06.1987
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