Calvinlito Lozada

Calvinlito Lozada | M EDICAL VA Lapu-lapu City, Cebu Philippines 6015 | - | Email:-LinkedIn: linkedin.com/calvinlitolozada | Upwork: https://tinyurl.com/bdenmh79 PROFESSIONAL SUMMARY My solid experience in prior authorization and insurance verification have helped DME providers minimize claim denials and ensure services rendered are covered. I am also proficient with patient registration, appointment scheduling, insurance portal navigation, document review and other admin tasks which will surely add value to your team. I am looking for a long-term employment and my goal is to learn the full revenue cycle so that you can fully utilize my skills. C O RE C O M PE TE NC IE S ✓ ✓ ✓ ✓ ✓ ✓ Prior Authorization Insurance Verification Patient Registration Patient Scheduling Calendar Management Medical Records Review T O O LS I’ V E ✓ ✓ ✓ ✓ HIPAA Compliance & Privacy EHR/EMR Proficiency Medical Terminology Data Entry ✓ ✓ ✓ ✓ ✓ Customer Service (Phone, Email or SMS) Technical Proficiency Detail oriented Reliable/Team player Resourceful/Adaptable US E D ➢ NikoHealth ➢ Vonage ➢ Slack ➢ Brightree ➢ Zocdoc ➢ RingCentral ➢ SRFax ➢ Tebra ➢ Zoom ➢ Microsoft Office Tools ➢ Salesforce ➢ HelloSign ➢ Google Workspace Tools ➢ Citrix ➢ CognitoForms ➢ Teams ➢ Waitwhile ➢ Oom Insurance Portals: Availity, UHC, UMR, Silversummit/Ambetter, HPN, Noridian, MyCGS Portal, NV Medicaid, Carelon, Evicore, Resmed, Hometown Health, Alignment Health, etc. W O RK H IS TO R Y Prior Authorization, VOB, Documents Reviewer | ISLEEP, LLC (DME/CPAP Provider) – Nevada USA March 2024 – March 2026 (2 years) • Process at least 40 authorization requests daily for DME services and made sure requirements follows payer guidelines. • • Minimized denial of prior authorization requests by ensuring required documents are attached, patient demographics and insurance info are accurate and requests are submitted. Call insurance companies to verify patient eligibility, check provider network status, limitation and requirements, copay/coinsurance, deductible, out-of-pocket maximum and accumulations. • Check provider portals for patient eligibility and benefits info. • Document in Niko Health the authorization information, update insurance information, upload clinicals and letters, notate process update and update task assignment. Appointment Scheduler | ACHILLES FOOT AND ANKLE (Podiatrists) – Virginia, USA February 2023 – November 2023 (9 months) • Attend daily stand-up meeting to report completed tasks and plans for the day. • Manage the schedules of more than 10 podiatrists on Tebra or Waitwhile by confirming, canceling, or rescheduling appointments following scheduling protocols. • Contact patients to collect insurance information and enter it into CogniForms for submission. • Register new patient’s information on Tebra while making sure every information provided is carefully checked to avoid billing issues or other problems in the future. • Respond to patient inquiries about their schedules, doctor’s information, office location, etc., while maintaining professionalism and delivering clear, accurate, and courteous communication at all times. Appointment Scheduler | PATH MENTAL HEALTH (Therapists, Psychiatrists) – REVA Global Medical Philippines February 2022 – January 2023 (11 months) • Answer the patient inquiries regarding provider availabilities, accepted insurance, etc., mostly via text messaging but also receive a few calls daily. • Matching patients with the right mental health physician. Schedule, cancel, and reschedule appointments for telehealth sessions. • Ensure HIPAA compliance, privacy regulations, and maintenance of patient confidentiality. Authorization Specialist | ADAPTHEALTH, LLC (DME/CPAP Provider) – Healthy Bos, Philippines March 2020 – November 2021 (1 year and 8 months) • Contact the insurance company to check the patient's eligibility, network status, and authorization requirements for HCPCs codes. • Gather documents like compliance report, prescriptions, face to face notes for the authorization request. • • Submit prior authorization request to the insurance via the portal, fax or call. Assist the supervisor and other VAs with the process. Extracting patient orders from the CRM to identify which requires verification and/or authorization requests. Member/Provider Services Rep. | HEALTHFIRST, New York USA (Insurance Company) - Concentrix, Philippines October 2018 – February 2020 (1 year and 4 months) • Providing health insurance coverage and benefits information to members and providers. • Processing member’s complaints, appeals, and grievances. • Providing claim denials submitted by doctors/hospitals and providing solutions. • Giving instructions to providers on how to submit appeals, authorization requests, submit a claim, and other billingrelated processes. Direct US Client | Freelance Virtual Assistant March 2012 – September 2013 (1 year and 6 months) • Creating content for Craigslist, Blogs, and Directories to enhance the online presence of a product. • Calling leads and ask if they would be interested in buying our DME products. • Basic SEO (On-page, Off-page) Customer Service/Tech Support Representative | Straight Talk (Telephone Company)- QUALFON, Philippines July 2010 – May 2011 (10 months) • Process replacement requests. Provide technical support assistance. • Change the customer’s phone number and/or register a new account. • Refill phone data, call, and text service plan. • Troubleshoot mobile phone problems C E R T I FI CA TE S • • • • HIPAA Training 2024 Medical Virtual Assistant Training 2024 HIPAA Training 2022 HIPAA Training 2026 E D U CA TI O N • Holy Name University – BS in Computer Science (Undergraduate) – S.Y-