Maria Idhonna Gay A. Matute

Maria Idhonna Gay Matute-Skype Id: yahiba_driena Educational Background School Year Attended Tertiary - Bachelor of Science in Nursing SY- Work Experience Company: ​ Shearwater Health Position: ​ Utilization Reviewer Year: ​ ​ May 2023 – May 2025 Duties and Responsibilities ●​ Analyzed medical records to assess the justification for procedures, hospital admissions, ongoing treatments, and diagnostic tests. ●​ Evaluated utilization patterns to ensure cost-effective, high-quality care delivery. ●​ Ensured compliance with payer-specific guidelines, CMS regulations, and accreditation standards. ●​ Collaborated with physicians, nurses, and other providers to obtain additional documentation and clarify clinical information. ●​ Processed pre-authorization requests and recommended approvals or denials based on clinical guidelines. ●​ Documented review findings clearly and accurately in internal systems. ●​ Contributed to improving care efficiency by identifying trends and potential overuse or underuse of services. _______________________________________________________________________________________ Company: ​ Bttn (Independent Contractor) Position: ​ Operation Specialist (Order Entry) Year: ​ ​ Sept 2024 – Nov 2024 Duties and Responsibilities ●​ Enter customer orders into the order management system (OMS) with accuracy, ensuring all required information is captured (e.g., product SKUs, quantities, customer details, shipping addresses, and payment methods). ●​ Review and verify order details for accuracy, including checking product availability, ensuring correct pricing, and confirming customer information. ●​ Monitor and track order status throughout the fulfillment process, addressing any delays, discrepancies, or issues promptly and communicating with relevant teams (e.g., sales, inventory, logistics) to resolve them. ●​ Act as the primary point of contact for customers regarding order status, inquiries, changes, and potential issues. ●​ Coordinate with internal teams (sales, inventory, fulfillment) to ensure smooth and accurate order processing, from entry to delivery. ●​ Verify product availability by collaborating with the inventory management team to ensure that products are in stock and ready for shipment. ●​ Track orders through the fulfillment process, ensuring timely shipment and keeping customers informed of any changes in delivery schedules. ●​ Maintain accurate records of all orders, including changes, cancellations, returns, and other updates, in the order management system (OMS). ●​ Update the OMS with any necessary changes or new information related to customer orders as they arise. _____________________________________________________________________ Company: ​ Complete Pain Care (Independent Contractor) Position: ​ Insurance Verifier Year: ​ ​ October 2023 – August 2024 Duties and Responsibilities ●​ Calling PCP for referral requests on behalf of the patient. ●​ Confirm insurance eligibility for both new and returning patients prior to their appointments through PrognoCis EMR Eligibility Checker and Insurance Portals like Availity, Cigna, UHC and EVS site. ●​ Updating patient charts through PrognoCis EMR. ●​ Demonstrated ability to protect patient privacy by implementing HIPAA compliance regulations. ______________________________________________________________________ Company: ​ BrightStar Care Laredo Site (Independent Contractor) Position: ​ Home Health Clinical Documentation Reviewer Year: ​ ​ January 2024 – August 2024 Duties and Responsibilities ●​ Review patient documentation (e.g., SOC, ROC, recertifications, visit notes) in KanTime EMR for completeness, clinical accuracy, and compliance with Medicare, Medicaid, and agency guidelines. ●​ Validate that documentation supports the plan of care and meets the medical necessity criteria for skilled services. ●​ Ensure timely submission and proper sequencing of OASIS assessments, physician orders, and visit documentation. ●​ Identify documentation deficiencies or inconsistencies and communicate findings to clinicians for correction or clarification. ●​ Collaborate with field staff, case managers, and QA supervisors to ensure accurate and timely charting. ●​ Monitor deadlines for documentation completion and address delays or missing records proactively. ●​ Assist in preparing for audits and accreditation surveys by maintaining organized, audit-ready records. ●​ Stay current with federal, state, and agency regulations relevant to home health documentation and billing. ______________________________________________________________________ Company: ​ Aptitude Medical Systems, Inc. Position: ​ Supervisor, Team Leader and Trainer Year: ​ ​ June 2020 – March 2023 (Full-time) Duties and Responsibilities ●​ I helped a large volume of customers every day with a positive attitude and focus on customer satisfaction. ●​ Trained agents in how to handle different types of inquiries, how to verify eligibility through insurance portal or by phone, how to use different software that is essential to the job, and how to designate different tasks needed to accomplish the company’s needs. ●​ Performed discovery calls with our competitors to learn more about their services. ●​ I am helping in filing insurance claims on behalf of the patients who submitted their insurance for reimbursement through AdvanceMD and, lately, in Office Ally. ●​ Setting up a provider account on different health insurance portals. ●​ Helping in verifying coverage, eligibility, and benefits of patient’s insurance through phone and portal. ●​ Processing patient refunds upon receiving the insurance claim reimbursements. ●​ Investigating and processing chargebacks in Stripe and Paypal. ●​ Transcribing audio research materials. ●​ Setting, canceling, and rescheduling appointments and handling refunds to patients if requested. ______________________________________________________________________________________ Company: ​ Psychotherapy Innovations Position: ​ Insurance Verifier and Biller Year: ​ ​ April 2020 – May 2022 Duties and Responsibilities ●​ Verified patient insurance coverage, eligibility, and benefits through payer portals and phone verification. ●​ Accurately processed insurance billing, claims submissions, and payment posting in alignment with payer guidelines. ●​ Managed patient profiles, documentation, and scheduling (intakes, rescheduling, cancellations) using TherapyNotes EMR. ●​ Assisted with billing corrections, refunds, and reconciliation of patient balances. ●​ Maintained HIPAA-compliant practices when handling patient health and billing information. ●​ Provided support with Kinnser software as a backup system for documentation and billing processes. ●​ Coordinated with providers and patients to resolve claim issues and ensure timely reimbursement. _______________________________________________________________________________________ Company: ​ Dooya Media Group Position: ​ Video Captioner Year: ​ ​ July 2020–November 2021 Duties and Responsibilities ●​ Created accurate, well-timed captions and subtitles for various video content, ensuring clarity and accessibility. ●​ Collaborated with the captioning team to plan, coordinate, and execute daily project deliverables. ●​ Ensured compliance with formatting standards and client-specific style guides. ●​ Reviewed and edited caption files for grammar, synchronization, and readability. ●​ Maintained high-quality output while meeting strict deadlines and multiple project timelines. ●​ Provided input on workflow improvements to enhance overall team efficiency and accuracy. _______________________________________________________________________________________ Company: ​ Alfredo E. Maranon Sr. Memorial District Hospital Position: ​ Staff Nurse Year: ​ ​ September 2019–March 2020 Duties and Responsibilities ●​ Delivered comprehensive nursing care to patients in adult medical, pediatric, and surgical wards. ●​ Conducted patient assessments, monitored vital signs, and documented clinical findings. ●​ Carried out physician's orders, administered medications, and assisted with medical procedures. ●​ Provided holistic, patient-centered care tailored to physical, emotional, and psychosocial needs. ●​ Collaborated with interdisciplinary teams to ensure safe and effective care planning and implementation. ●​ Educated patients and families on treatment plans, post-discharge care, and health maintenance. ●​ Maintained accurate and up-to-date patient records in compliance with hospital policies and nursing standards. _______________________________________________________________________________________ Company: ​ DIADEM INVESTMENTS (Independent Contractor) Position: ​ Real Estate Administrative Assistant Year: ​ ​ January 2019 – September 2019 Duties and Responsibilities ●​ Cold calling ●​ Setting up appointments for those interested in selling or buying properties. ●​ Skiptracing properties and their status through Propstream. ●​ Skiptracing information about leads through a free platform like truepeoplesearch.com. _______________________________________________________________________________________ Company: ​ MGM CAPITAL INVESTMENTS (Independent Contractor) Position: ​ Outreach Associate (Appointment Setter in a Real Estate Company) Year: ​ ​ June 2018 –December 2018 Duties and Responsibilities ●​ Cold calling ●​ Setting up appointments for those interested in selling or buying properties. ●​ Handling tickets and managing Zendesk CRM. _______________________________________________________________________________________ Company: ​ BIBO GLOBAL OPPORTUNITY, INC. (Independent Contractor) Position: ​ Online English Tutor (Part-time) Year: ​ ​ December 2016–June 2018 Duties and Responsibilities ●​ Delivered one-on-one online English lessons to students of various nationalities and proficiency levels. ●​ Developed and customized lesson plans to meet individual learning goals in grammar, pronunciation, vocabulary, and conversational skills. ●​ Provided constructive feedback and corrections to improve students' fluency and confidence in English communication. ●​ Monitored student progress and adapted teaching strategies to ensure effective learning outcomes. ●​ Maintained punctuality, professionalism, and cultural sensitivity in all tutoring sessions. ●​ Utilized the company’s online platform and digital teaching materials to create an engaging virtual classroom experience.