Karen Grace Raquiza

Karen Grace V Raquiza Address: VIP Village, Laray Inayawan, Cebu City 6000 Contact #: - Email address:-- POSITION DESIRED: Virtual Assistant PROFESSIONAL EXCELLENCE SUMMARY • Prior Authorization • Insurance Verification • Appointment Setting • Inbound, Outbound and Voicemail • Telemedicine • EHR • Health Care Provider and Patient Support • Accounts Receivable • Credentialing • Clients and brokers support phone, email and chat. • Health Insurance Processing and Underwriting. • Licensing and Appointment Processing Renewals and Certification. • Effective verbal and written communication skills, interpersonal skills and good team coordination. PERSONAL SKILLS Reliable and Professional Resourceful Organized & Detailed Oriented Team Player Open to Challenge PROFESSIONAL EXPERIENCE Health Virtual Assistant Integrative Medicine LLC April 29, 2019- June 01, 2022 Prior Authorization Insurance Verification Appointment Setter Telemedicine Inbound , Outbound, Voicemail and Fax Health Care Provider and Patient Support- ( Medical Records Request; Medication Prescription Request; Lab Orders and Diganostic Orders, Lab and Procedure Results, Referrals Charting and Telemedicine ) Updating Patients Demographic on EHR (electronic health care records) Credentialing Coordinator Pmaxglobal Cebu Branch December 17, 2018 to April 24, 2019 Enrolling healthcare providers in governmental and commercial payer networks. Oversees the initial client set up for new practices and maintains a current database of credentials and enrolment information. Accurately complete payer credentialing and facility appointment applications for providers. Provides support and assistance for new practice setup as needed. Track progress of outstanding applications and communicate with provider relation representatives ensuring enrolment completion. Maintains accurate and current information in the provider records which includes credentialing software database and in provider electronic folders. Maintains credential files in an orderly and current manner. Provides research and administrative support for special projects. Ensures HIPAA guidelines are respected by safeguarding protected health information in the capacity of the position and responsibilities. ACCOUNT RESOLUTION SPECIALIST Central Billing Bureau Independent Contractor: August 10, 2017 to December 10, 2018 •Collect and enter claim information. •Post insurance and patient payments and manage accounts. •Submit claims and follow up with insurance carriers on unpaid or rejected claims. •Prepares appeal letters to insurance carrier when not in agreement with claim denial. • Collects necessary information to accompany appeal. CREDENCIALING COORDINATOR CREDXLLC Independent Contractor: August 10, 2017 to December 10, 2018 •Responsible for processing, leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing for our Allied Healthcare Professional clients. •Facilitates all aspects of credentialing, including initial appointment, reappointment, expiable process, as well as clinical privilege for Medical Staff, •Ensure s interpretation and compliance with the appropriate accrediting and regulatory agencies, •Responsible for the accuracy and integrity of the credentialing database system and applications. Medicare and Health Insurance Application Processor and Underwriter Licensing and Appointments Coordinator Finance - Commission Auditor Broker Support HSA for America/ Wiley Long Enterprises, Inc. Contractor: October 2011 – June 29, 2017 Health Insurance Application Processor and Underwriter Processing our clients Health and Medicare Insurance Input Clients data on our Excel shortlist, underwriting and client’s CRM record. Checking Clients Insurance application, making sure all information’s are filled, signed and dated by both client and broker. Faxing and E-mailing clients application to Insurance Company. Following-up on Status of Clients Application with the Insurance Company. Documenting Information’s gathered. Uploading clients Application in their CRM filebox. Perform weekly reporting of daily activities. Licensing and Appointments Coordinator Renew Agency’s License and Appointment and other Legal Documents. Making sure our Agency and Brokers are always legal to sell in all US states where we do our business. Store Agency’s and Broker’s License, Certificates and all other Important Documents in Google Drive. Reminding Broker’s under the company of their License renewal dates and certification using Google Calendar and via email. Do Research and Contact Prospected Carriers we want to be appointed. Manage Carrier and Up-line Contact Sheet and PBC State Appointment Trackers, License Tracker in Google Drive. Making sure all information's are organized up to date and accessible in our system. Manage SureLC , a desktop application another tool we use to keep track of our license and appointment Assist Broker and Team mates if they need important information regarding Brokers Information. Performs Weekly Report for Carrier On-boarding and Off-boarding. Finance - Commission Auditor Responsible in Preparing Commission Payment Worksheet, Bonus Payment Tracker Monthly. Handles Brokers Commission Questions and Issues, research and follow-up when needed. Performs Monthly Update on PBS Commission Running and monitor commission issues. Responsible in Auditing Reports making sure our agency and our brokers are being paid correctly by regularly Responsible To follow-up Commissions that was not paid. Weekly Finance Reporting Via Skype Conference Call. Update Clients GBS Record (a desktop tool in tracking all commission payments) making sure information there are identical with Clients CRM Records. Responsible to Update Task Documentation Process. EDUCATION Graduated Bachelor of Science in of Science in Nursing in University of the Visayas June 2005- March 2009 Undergraduate of Bachelor of Fine Arts Major in Advertising Arts in University of San Carlos Tech. Center June 1995- Oct 1998 High School in University of San Carlos Girls High School Dept. June 1991- March 1995 Elementary in University of San Carlos Elem. Dept. June 1985- April 1991 CHARACTER REFERENCES To be given when requested.