JANET DELA ROSA
GLENDALE,California
Summary
Medical Billing and Coding Specialist with 11 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Case Manager
Law Offices Of JacobEmrani
09.2018 - Current
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Oversee and manage approximately 120 to 185 pre-litigation matters with the assistance of the assigned pod leader and Firm support staff;
- Interview clients, witnesses, and law enforcement officers;
- Contact third party and first party insurance carriers to open insurance claim;
- Open Medi-Cal and/or Medicare claim on behalf of the client;
- Gather police reports and other supporting evidence;
- Conduct research on third party, including asset search, policy limits, etc.;
- Request, receive and document medical information;
- Assist client in resolving client’s property damage claim (i.e. set up inspection, reimbursement for storage and tow charge, reimbursement for rental expense and/or loss of use, and coordinate execution of property damage releases and payment);
- Communicate and correspond with client regarding medical treatment and current symptoms;
- Communicate and correspond with claims adjuster and treating medical providers;
- Participate in monthly file reviews with assigned Personal Injury attorney;
- Gather all necessary documents for demand writing team;
- Negotiate settlements with claims adjuster;
- Assist client through the settlement process, including communicating all offers/counter-offers.
- Maintain electronic and hardcopy files in accordance with the Firm's policies and procedures;
- Responsible for actively medically managing each assigned matter with Attorney approval, including reviewing medical reports and medical recommendations, assisting with scheduling medical appointments, obtaining referrals for additional medical treatment, appointment reminders, etc.;
Medical Claims Specialist
Mafraq Hospital
01.2012 - 01.2016
- Submitted electronic/paper claims documentation for timely filing.
- Monitored and updated claims status in claims processing system.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Followed up on denied claims to verify timely patient payment and resolution.
- Researched and resolved complex medical claims issues to support timely processing.
- Generated, posted and attached information to claim files.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
Medical Coder and Billing
DAMAN -National Health Insurance
10.2005 - 11.2011
- Updated patient financial information to guarantee accuracy.
- Assigned appropriate medical codes with 99 percent accuracy rate.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Trained and mentored junior coders to support growth and development and apply high-quality coding practices.
- Utilized electronic medical record systems to store, retrieve and process patient data.
Medical Claims Processor
NextCare
10.2005 - 06.2007
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Verified patient insurance coverage and benefits for medical claims.
- Paid or denied medical claims based upon established claims processing criteria.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Processed insurance payments and maintained accurate documentation of payments.
- Researched and resolved complex medical claims issues to support timely processing.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Monitored and updated claims status in claims processing system.
Pharmacist
Philamcare
06.1998 - 01.2001
- Reviewed prescription to confirm appropriate selection of drug, dose and check for interactions with other medications.
- Interpreted prescription orders, dispensed medications, and counseled patients on drugs.
- Maintained appropriate drug records and completed reports as necessary.
- Educated patients about possible drug interactions and gave special administration instructions.
- Prepared medications in blister packs to provide safe and convenient way to take prescribed medication.
- Complied with pharmacy regulations to increase quality of health care and inhibit criminal abuse of drugs.
- Assessed patient knowledge of chosen therapy to tailor counseling to meet needs of individual patients.
- Evaluated drug therapy to drive appropriate medicine use.
Education
MBA - Business Administration
California Trinity School of Business
Los Angeles, CA06.2022
Bachelor of Science - Pharmacy
Philippine Women's University
Manila,Philippines10.1993
Bachelor of Science - Biology
Adamson University
Manila Philippines03.1991
Skills
- MS Office
- Multitasking and Organization
- Medical Records Management
- Telephone Etiquette
- Data Abstraction
- 3M Encoder
- Medical Claims Coding
- ICD-10 (International Classification of Disease Systems)
Certification
Certified Medical Coder-AAPC
Timeline
Case Manager
Law Offices Of JacobEmrani
09.2018 - Current
Medical Claims Specialist
Mafraq Hospital
01.2012 - 01.2016
Medical Coder and Billing
DAMAN -National Health Insurance
10.2005 - 11.2011
Medical Claims Processor
NextCare
10.2005 - 06.2007
Pharmacist
Philamcare
06.1998 - 01.2001
MBA - Business Administration
California Trinity School of Business
Bachelor of Science - Pharmacy
Philippine Women's University
Bachelor of Science - Biology
Adamson University
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