Pia Alexandra Cañega

PIA ALEXANDRA CAÑEGA Medical Virtual Assistant-| (- | Bacoor, Cavite, PH Professional Summary Highly dependable and HIPAA-certified professional with over 5 years of experience in healthcare support, case management, and BPO healthcare operations. Proficient in insurance claims processing, medical coordination, and appeals management with strong working knowledge of various EHR/EMR systems. Demonstrates exceptional attention to detail, communication, and administrative efficiency. Adept at managing sensitive patient data and aligning workflows with regulatory and clinical protocols—ideal for remote medical virtual assistance roles. Key Skills & Competencies • • • • • • Medical Case Management & Coordination Insurance Claims Verification & Appeals Skilled Nursing Authorization Processing HIPAA Certified & Compliance-Driven EHR/EMR Platforms Clinical Documentation & Utilization Review Reporting • • • • • • Inbound/Outbound Healthcare Communication Microsoft Office Suite & Google Workspace EMR Workflow Management & Data Entry Email & Calendar Management Strong Analytical & Problem-Solving Skills Internet Research & Medical Data Validation Professional Experience ISTA Solutions Inc. — Case Management / Appeals Specialist June 2022 – Present • Oversaw 100+ monthly appeal cases related to skilled nursing authorizations, contributing to a 25% claim reversal rate through strategic follow-up and accurate documentation. • Partnered with insurance providers, healthcare professionals, and facility administrators to secure preauthorizations and streamline communication. • Led weekly documentation reviews including clinical notes and UR reports for compliance and internal case audits. • Utilized various EHR platforms to log, track, and escalate denied claims and appeal statuses. ISTA Solutions Inc. — Case Management Specialist August 2020 – June 2022 • Managed communications with insurance companies, medical providers, social workers, and case managers to coordinate care plans and resolve delays. • Filed authorizations and conducted follow-ups that improved turnaround time by 15% and reduced pending case volume. • Submitted medical records, logs, and clinical documentation required for weekly case monitoring and authorization processing. Conduent Business Services Philippines Inc. — Customer Experience Associate January 2018 – July 2020 • Handled 75+ healthcare-related inquiries daily, providing frontline support for benefit verification and claims clarification. • Verified policy eligibility, member coverage, and claim status, ensuring accurate information delivery and resolution pathways. • Proactively followed up on member concerns, contributing to a 95% customer satisfaction score through clear and empathetic communication. Education Pamantasan ng Lungsod ng Maynila Manila, Philippines | 2012 – 2017 Bachelor of Science in Social Work • Passed the 2017 Social Work Licensure Examination Certifications • • Certificate of Completion – Teach Me HIPAA, March 18, 2025 Prior Authorization Training Course March 23, 2025 • Insurance Verification Training Course March 22, 2025