Marissa Del Mar

Marissa del Mar - - / - Value Statement: Nothing speaks louder than a life full of integrity. Summary of Qualifications: 1. Comprehensive knowledge of medical billing procedures, insurance claims processing, with strong exposure to ABA billing, analytical and problem-solving skills that can effectively interact professionally with providers and insurance representatives. Manage, coach and develop team members in the optimal execution of operations activities working with multiple EHR and EMR. Help bridge the gaps that lead a team to successfully meet or exceed their goals. Professional Experience October 18, 2024 – February 2026 Medical Billing Specialist / Quality Assurance Specialist Remote Medical Billing Specialist / Quality Assurance Specialist • Maintain confidentiality and comply with HIPAA regulations and Revenue Cycle Management • Manages full billing cycle for pediatric ABA, Speech and Occupational Therapy across several states in the US for US payers (Commercial). • Submit clean insurance claims electronically and manually for ABA services rendered. • Secure accurate payments from insurers, verifying correct reimbursement rates, and appealing any billing issues that come up. • Monitor and manage accounts receivable, including following up on unpaid or denied claims, charge entry and payment posting. • Communicate with clinical staff to verify documentation compliance and session accuracy. • Accurately post ERA/EOB payments, adjustments, write offs, and denials in the billing system. • Coordinate with insurance payers to verify denials and discuss possible solutions. • Conduct medical record audits to ensure all billed services are fully supported by appropriate documentation. Programs and tools used: ✓ Availity ✓ Change Healthcare ✓ CentralReach ✓ IRIS Insight ✓ Waystar ✓ NPPES NPI Registry ✓ ClickUp December 20, 2021 – September 15, 2024 Carelon Global Solutions Taguig City, Philippines Assistant Manager: National WGS – Provider Services Oversee and support healthcare associates focusing on members’ eligibility, benefits, claims and grievances and appeals. Maintains scorecard, productivity, capacity and inventory reports for accurate tracking of data. Web Coaching, Genesys Cloud and Workday • Associates’ performance and time tracking Aspen, Solcen, NextGen, CRIS System, ACMP, Claims Archive, ACMP, UM Intake • Tools used in assisting clients with members’ concerns May 2019 – December 8, 2021 TELUS International Philippines Quezon City Philippines Operations Team Leader Leads and manage telecom associate’s and other telecom related concerns. • Conducts performance management for team members • Handling escalation calls to provide more strategic solutions on members inquiry April 2017 – April 2019 TELUS International Philippines Quezon City, Philippines General Administration Analyst • Manages key reports such as Board Hours and Bill to pay of the program • Administrative support for the program cluster by coordinating with various internal departments for resolutions, inquiries, issues and cascades of information August 2006 – April 2017 TELUS International Philippines Quezon City, Phiippines Front line Associate (Subject Matter Expert) • Provides support to associates with product related concerns • Inbound and Outbound call to address customers queries regarding phone lines, internet and cable installations and add up features like long distance plans, toll free’s, etc. • Order processing of clients’ phone, internet and cable connections. Relevant Training: General Admin Virtual Assistant - training knowledge • Buyer and seller real estate practices include documentation per transaction type. • MLS property search and listing process including legal property description requirements • Offer preparation, basic forms and terms and conditions within contracts  • Transaction Coordination timeline, pertinent documents required for sale and escrow Quality Audit Certification • Live and recorded call audit of associates phone time Coaching for Excellence Training • Coaching Excellence Leadership Primer • Coaching Concepts • Fundamental Coaching Skills Learning & Development Personal Empowerment Program • Brand Me: Personal Visioning • Growth Begins Within: Enhancing your confidence • Embracing Change: Managing Personal Transitions • Achieving Win-Win Situations: Being a Team Player • Maximize Yourself: Workshop on Time & Stress Management Education June 1998 – April 2006 Technological Institute of the Philippines Quezon City, Philippines Bachelor of Science in Commerce – Major in Management