Francis Ian Dimayuga

FRANCIS IAN DIMAYUGA Insurance Verification Specialist Dedicated and detail-oriented Insurance Verification Specialist with 4 years of experience. Eager to apply proven-insurance verification skills for US insurance eligibility and benefits verification and ensuring all payer forms, notifications, and authorizations are completed within the required timeframe. Special interest in excelling with medical pre-authorization. EDUCATION Alternative Learning System (ALS) High School Completed in 2008 CONTACT-- Malvar, Batangas, Philippines 4233 ACHIEVEMENTS March 2023 – April 2023 Configured EDI receiver for all payers of a newly transitioned EMR (E-Clinical) to make all insurances up and running in terms of automatic eligibility verification Sept 2022 – November 2022 Most reliable Lead Agent Provide assistance to operations, training and nesting PROFESSIONAL EXPERIENCE MVM Health LLC - Insurance Verification Specialist | Pre-Auth Specialist | Front Desk March 2023 – Present Key responsibilities: Manual eligibility and benefits verification and make sure all patients are eligible before the date of actual appointment Interpret payer coverage information including network participation status with the provider, limited plan coverage, and inactive benefits Configure EDI receiver to make sure all payers in EMR are up and running Qualify DME eligible patients for a specific HCPC code Check and submit DME pre-authorization Follow up on rejected/denied claims Enroll providers for insurance contracting Answer inbound calls from patients and providers regarding scheduling, re-scheduling, cancellation, document request and other inquiries Update and upload medical documents in EMR Coordinate with different providers regarding referral Assist providers in completing EMG notes HealthyBOS - Insurance Verification Specialist | Documentation Specialist | Lead Agent August 2021 – November 2022 Key responsibilities: Verify patient's insurance eligibility and benefits thru online portals and by calling insurances Interpret payer coverage information including network participation status with the provider, limited plan coverage, and inactive benefits Verify and chase medical documents (prescriptions, doctor's evaluation and chart notes) Coordinate with different providers thru calls and fax Coordinate with the credentialing team to escalate contracting issue Call patients to provide real time DME order status, advise COB issues and to obtain active insurance Facilitating training classes for new hires and getting them ready for certification and nesting Provide real-time support to operations in terms of processes The Results Companies - Coach | Customer Service Representative (Member Services) October 2016 – April 2019 Key responsibilities: Answer inbound calls from insurance members Assist insurance members with eligibility and benefits inquiries, claims, authorizations and appeals Verify provider's network status Assist insurance members in selecting the best insurance plan that suits their needs Calling pharmacies to request a refill or resolve any medication refill issue Provide accurate medication copays and coinsurances Educate members on the medication tiers, restrictions and coverage determination process Provide an urgent care by assisting members in getting a medication temporary override Resolve grievances and complaints in most empathetic way Assist members on plan cancellation of enrollment and disenrollment Floor visibility to assist agents real time during phone time Listen and monitor agent's live and recorded calls Root Cause Analysis and coach agents on the opportunities identified on the call Create LOB's KPI analysis and action plans for score improvement Identify issue trends and create action plan recommendation to clients for business improvement Real time monitoring of Service Level Create readouts of grievances filed by customers to the business and come up with action plans CTM (Complaint to Medicare) meeting with the clients Admin tasks (EOD reports, Masterlist, Agent KPI reports, etc.) TOP SKILLS Hard Skills Insurance Verification EMR Management HIPAA Customer Service DME Pre-Authorization Medical Front Desk Basic Medical/Prescription Billing Data Entry Team Management Coaching Root Cause Analysis KPI Analysis Basic Workforce Management Cold Calling Basic Social Media Management Soft Skills Observation Decision Making Communication Multi-tasking TOOLS E-Clinical Dr. Chrono SNAP Brightree CareConnects COS Emdeon Availity Navinet OneSource Noridian Carelon (AIM) Evicore Cohere Echo Gentem Trizetto Salesforce Zendesk Oracle Genesys PureCloud RingCentral i3 ViciDial Microsoft Sharepoint Microsoft Office (Excel, Word, Powerpoint) Google Workspace Canva MS Teams Zoom Slack Capcut