Glaiza Baturiano

GLAIZA BATURIANO -Caloocan City, Metro Manila, Philippines • - SUMMARY Detail-oriented and experienced Medical Biller with a strong background in revenue cycle, specializing in claim denials, submission and denial resolution. I help healthcare providers and businesses maximize revenue by ensuring accurate and timely billing, reducing claim rejections, and accelerating reimbursements from insurance payers. Skilled in verifying patient insurance, applying correct CPT, ICD-10, and HCPCS codes, and working within billing platforms to submit clean and corrected claims. I proactively resolve billing issues, conduct follow-ups on unpaid claims, and resolving denials and payment descrepancies, all while maintaining full HIPAA compliance. By identifying billing trends, preventing costly errors, and streamlining claim workflows, I reduce A/R days and support healthier cash flow for my clients. I thrive in fast-paced environments, take ownership of my responsibilities, and provide dependable billing support that contributes directly to business growth and operational efficiency. EDUCATION Partido State University Bachelor of Science in Business Administration Major in Financial Management April 2018 - May 2022 WORK EXPERIENCE HEALTHCARE COLLECTIONS REPRESENTATIVE Aug 2022 - May 2025 OPTUM GLOBAL SOLUTIONS Follow up on outstanding claims via phone, web portals, and written correspondence to ensure timely reimbursement. Monitor claim aging buckets (30/60/90/120+ days) and apply targeted follow-up strategies to recover old and high-value balances. Cross-check reimbursements against expected payment to ensure accurate and complete payments. Identify claim denials and underpayments; submit appeals and corrected claims with supporting documentation. Investigate and resolve insurance discrepancies to recover maximum revenue from both commercial and government payers including Medicare and Medicaid. Identified eligibility issues impacting claim processing, followed up with payers or patients to obtain updated information, and took corrective actions to avoid payment disruptions. Documented all eligibility findings and updates in patient accounts and billing systems to support claim accuracy and audit compliance. Initiate timely rebilling or corrected claim processes to address coding, modifier, or demographic errors. Review aging reports and prioritize high-balance and high-risk accounts for accelerated resolution. Maintain accurate documentation of all collection activities in billing software and EMR systems. Communicate with payers and patients to clarify balances, resolve billing concerns, and facilitate payment arrangements. Analyze claims trends and collaborate with internal teams to adjust coding and documentation as needed. Stay updated with payer-specific guidelines, coding updates, and reimbursement policies. Escalate complex claim issues to supervisors or compliance teams when appropriate. Coordinate with providers, billing teams, and patients to resolve authorization, medical necessity, coding, timely filing or eligibility issues. Maintain strict confidentiality and compliance with HIPAA and federal regulations in all patient-related transactions. Meet or exceed monthly collections goals, maintaining high standards of quality and productivity in a remote setting. Support additional tasks as assigned by the department manager. TOOLS AND SOFTWARE Host System, Soarian, EFR, Claims Administrator, Cerner, DDE, PIC, Microsoft Excel, Outlook, Word Insurance Portals: Noridian, Availity, Medpoint, DHCS, Health Net, Cigna, UHC, Kern, CCAH, etc. CORE SKILLS AND COMPETENCIES Insurance Denial Resolution and Appeals Claims Reprocessing and Rebilling Eligibility and Benefits Verification Explanation of Benefits (EOB) Analysis Medical Billing and Collections AR Follow-Up HIPAA Compliance Payer Communication (Phone/Web/Correspondence) Patient and Insurance Letter Writing and Documentation Cross-Functional Team Collaboration CERTIFICATION HIPAA Training Certified