Jenesis David

Jenesis David PROFESSIONAL SUMMARY Detail-oriented and dependable Medical Virtual Assistant with over three years of experience in healthcare support, specializing in insurance verification, clinical review, and administrative tasks for US-based clients. Proficient in EHR systems, HIPAA-compliant workflows, and remote communication. Known for strong organizational skills, fast learning ability, and consistent high-quality performance in fast-paced environments. Seeking to contribute to a dynamic remote healthcare or executive support team through reliable virtual assistance. PROFESSIONAL EXPERIENCES Clinical Review Analyst​ TaskUs Philippines​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 - 2025 Clark, Philippines ●​ Reviewed and analyzed high volumes of medical records, clinical documentation, and provider notes to ensure accuracy and compliance with insurance and healthcare standards ●​ Verified CPT and ICD codes, ensuring alignment with payer policies and utilization guidelines to support claim approvals and medical necessity ●​ Maintained strict HIPAA compliance in handling sensitive patient health information (PHI) ●​ Supported end-to-end clinical review workflows, including pre-authorizations, appeals triage, HMO referral intake, and escalation handling ●​ Conducted insurance verification and pre-auth eligibility checks using platforms such as Lighthouse and Rosco ●​ Scheduled peer-to-peer calls and specialist appointments as part of the prior authorization process ●​ Handled non-verbal communications for prior authorization determination via internal systems ●​ Verified if HMO referrals were eligible and confirmed if the referring provider accepted the member ●​ Reached out to members to inform them about prior auth determinations and next steps ●​ Verified claim submission deadlines and ensured adherence to timely filing requirements ●​ Reached out to providers/facilities to confirm or correct phone and fax numbers, and to follow up on claim submissions, refunds, and portal issues ●​ Provided basic troubleshooting support for providers with portal access issues, including guidance on two small deposit verification. ●​ Informed providers and members about Single Case Agreement (SCA) procedures for out-of-network cases ●​ Forwarded completed cases to the appropriate nurse or processor for determination ●​ Reported end-of-shift status and submitted dashboard screenshots to ensure all tickets were addressed before logging out ●​ Maintained high productivity and accuracy in a metrics-driven remote environment ●​ Handled inbound/outbound calls to providers, facility, members, and insurance representatives. ●​ Managed an average of 30+ inbound/outbound calls and resolved 100+ non-verbal tickets per day, maintaining a consistently low Average Handle Time (AHT) while ensuring accuracy and HIPAA compliance. ●​ Handled around 10 provider outreach tickets daily, each requiring investigation of unique claim or portal-related scenarios, and coordinated resolutions through accurate documentation and follow-ups. Sales and Service Representative​ ​ iQor Philippines​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 - 2022 Davao, Philippines ●​ Provided exceptional customer support via phone, chat, and email for US-based clients during peak seasons ●​ Processed customer orders and resolved issues in a timely and professional manner ●​ Maintained high service-level standards and contributed to order fulfillment success ●​ Demonstrated adaptability in a remote support environment and met quality and performance benchmarks Online ESL Instructor​ Gngn Eikaiwa Phils. Inc.​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2021 - 2022 Clark, Philippines ●​ Conducted engaging 1-on-1 and group lessons for Japanese students aged 6 to 60 ●​ Customized teaching strategies to match student age and skill level ●​ Supported learners in improving verbal and written English through real-life conversation scenarios ●​ Maintained a consistent teaching schedule and ensured a professional, encouraging learning environment SKILLS AND TOOLS Electronic Health Records (EHR) & EMR Systems Rosco, FaxBlast, Lighthouse, Jira, Blackbird, Slack HIPAA Compliance & PHI Management Insurance Verification & Pre-authorizations CPT and ICD Code Validation Claims Processing & Appeals Handling Calendar Management & Scheduling Google Workspace (Docs, Sheets, Gmail) Microsoft Office Suite (Excel, Outlook, Word, Teams) CRM and Ticketing Systems Strong Written & Verbal Communication ●​ Inbound/Outbound Communication & Troubleshooting Support ●​ Remote Collaboration & Time Management ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ EDUCATION Holy Angel University​ Senior High School​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Systems Plus College Foundation​ ​ ​ ​ ​ Bachelor of Science in Entertainment and Multimedia Computing​ ​ LANGUAGES ●​ English ●​ Tagalog ●​ Kapampangan Angeles City, Philippines Angeles City, Philippines ​ ​ ​