Kevin Ariola

KEVIN ALCAZAREN ARIOLA -- PROFESSIONAL PROFILE: Proficient in computer and MS Office Programs (Word, Excel, Outlook, PowerPoint, Visio) Advanced knowledgeable in data analytics and SQL Good communication and interpersonal skills Fast-learner and can maximize resources for problem solving 3 years’ experience of handling outbound calls 3+ years in client facing role 9+ years combined experience in claims analyst (1.7), billing (5), workflow and data analysis (3+) Software used: Citrix, PAI, Facets, JIRA, SQL, Cerner Well-versed in analyzing data and problem solving KEY SKILLS: Client relationship management Client engagement Data Analytics Requirements gathering Triage, troubleshooting, and problem solving JIRA navigation Updating, maintaining, and testing workflow updates POSITIONS/ INDUSTRIES WORKED: Healthcare - IT Healthcare accounts for both insurance and providers Medical Claims Processing Denial Management Billing Authorization PROFESSIONAL EXPERIENCE: Conifer Global Business Center, Taguig City January 2020 – Present Process Engineer Analyze and define product requirements to ensure the best solutions for business and market needs. Act as the agile/scrum product owner, attend daily stand-ups, guide the team, and remove any blockers. Work closely with developers and QA teams to deliver solutions that meet business and user needs. Prioritize tasks for yourself and the team, manage the agile backlog, and track user story progress. Document product features and enhancements. Set up configurations to meet different client and market segment needs. Update workflows based on new findings and present changes to the team, including managers and clients. Resolve conflicting inputs from different sources, ensuring existing functionality is not impacted by current clients. Build strong working relationships with developers and QA to improve communication and problem-solving. Review development work, conduct User Acceptance Testing (UAT), and ensure it meets requirements. Participate in team retrospectives to identify improvements and suggest changes. Support documentation and help resolve issues according to service level agreements (SLAs). Billing Representative Review claim forms (both UB04 and HCFA 1500) Handle special project Analyze denials and coding, credentialing and eligibility requests Bill payer with completely correct claims Was assigned to a stand-alone process Communicate process clarifications and updates directly with onshore partners Verify patient and payer information Project Implemented: Job Aide structure reengineer Built Job Aids for New hires – how the system works/operates Proofread and update existing Job Aides to be aligned with the process Facilitated weekly meetings with Senior Directors to provide updates with the project Project sign off with positive feedback and score in UAT with 98.8 percent Optum Global Solutions, Quezon City Feb 2017 – Jan 2020 Billing Representative Check eligibility of the patient Send clinical notes/medical records to proper payer Make a follow up call for authorization Review claim denials Coordinate with the insurance/ payer with proper patient information Accenture Philippines, Mandaluyong City June 2015 – Feb 2017 Data Analyst/Claims Processor Review and process high-cost claims Handle appeals, grievances, and denials Detect fraud Solve problems in paying or denying claims Compute correct prices for the customer’s bill Belong to a complex team function INTERNSHIP EXPERIENCE: April 2014-May 2014 Land Bank of the Philippines Cash Department EDUCATION: June 2011- April 2015 Bachelor in Banking and Finance Polytechnic University of the Philippines Dean’s Lister TRAININGS: Feb 2021 – April 2021 Lean Six Sigma Green Belt International Management Consultancy July 2010 – Oct 2010 Computer Literacy Training Program Diliman Computer Technology Institute Commonwealth Avenue, Diliman, Quezon City