Ronald Nadera

RONALD ALIPIO NADERA Cebu, Philippines PROFESSIONAL SUMMARY Results-driven Healthcare Operations Specialist with 7+ years of experience supporting U.S. healthcare payers, providers, and BPO operations. Proven expertise in claims processing, denial management, eligibility verification, prior authorization, and revenue cycle support. Strong background in team leadership, quality assurance, and process improvement. Adept at handling high-volume workloads while maintaining accuracy, compliance, and SLA performance. Seeking a remote role in healthcare operations, medical billing, or customer success. CORE SKILLS • Healthcare Operations: Claims Processing, Denials & Appeals, Eligibility & Benefits Verification, Prior Authorization, Revenue Cycle Management, Provider & Member Services • Leadership & QA: Team Leadership, Coaching, Quality Assurance, SOP Development, Training & Onboarding, Escalation Management • Systems & Tools: EMR/EHR, Payer Portals, CRM Systems (UHOPS, MTV, CAS), Microsoft Office, Google Workspace • Compliance: HIPAA Compliance, Data Privacy, Documentation Accuracy PROFESSIONAL EXPERIENCE US Clinic Coordinator (Contract) Snapscale | Sept 2025 – Mar 18, 2026 • Coordinated daily operations for a U.S.-based clinic, managing patient scheduling, provider calendars, and intake workflows • Handled inbound/outbound calls for patients, providers, and payers; resolved inquiries on appointments, referrals, and care coordination • Performed eligibility & benefits verification, prior authorization follow-ups, and referral tracking • Supported claims follow-up and basic billing inquiries; liaised with billing teams to resolve denials and rejections • Maintained accurate, HIPAA-compliant documentation in EMR/EHR and CRM systems • Collaborated with providers and clinical staff to ensure continuity of care and timely service delivery • Met SLAs for call handling, documentation accuracy, and turnaround times in a highvolume environment Claims Representative (Contract) Emapta Philippines | Mar 2025 – Aug 2025 • Processed high-volume medical claims in compliance with payer guidelines and HIPAA regulations • Resolved denied/rejected claims through payer portals and documentation review • Supported providers with billing corrections, claim status, and payment inquiries • Consistently met productivity, quality, and turnaround time KPIs Executive Assistant SUGE Enterprises | Jan 2025 – Apr 2025 • Managed executive calendars, meetings, and confidential communications • Coordinated administrative workflows and reporting • Handled sensitive documentation with high accuracy and discretion Homecare Coordinator / Scheduler RCP Medical Staffing | Aug 2024 – Dec 2024 • Coordinated patient schedules with clinicians and providers • Maintained accurate EMR documentation and service records • Verified authorizations aligned with patient care plans Senior Team Leader RCP Billing & Call Services | Apr 2024 – Aug 2024 • Led healthcare support team handling patient and provider inquiries • Managed escalations and complex case resolution • Conducted QA monitoring, coaching, and performance improvement • Supported training and workflow optimization initiatives Customer Care Representative (Telco) Accenture | Jan 2024 – Mar 2024 • Handled billing, account, and service inquiries for telecom customers • Resolved issues while maintaining high CSAT and quality scores • Documented interactions accurately in CRM systems Subject Matter Expert (Healthcare) Wipro Ltd. | Apr 2022 – Oct 2023 • Supported operations as SME for healthcare accounts • Delivered training sessions and knowledge transfer programs • Developed SOPs, job aids, and process documentation • Assisted QA reviews and performance improvement plans Healthcare Customer Service Representative Optum Global Advantage | Jul 2020 – Dec 2021 • Provided claims follow-up and EOB explanations • Assisted providers and members with billing and coverage inquiries • Ensured HIPAA-compliant documentation and account handling Assistant Team Leader / SME Conduent Business Services | Jun 2018 – Feb 2020 • Supported daily operations, reporting, and agent coaching • Handled escalated and complex member concerns • Assisted leadership in KPI tracking and performance management Customer Service Representative Hawaiian Airlines (Teleperformance) | May 2017 – Oct 2017 • Assisted customers with bookings, itinerary changes, and travel concerns • Maintained high customer satisfaction and service standards EDUCATION Bachelor of Science in Information Technology Consolatrix College of Toledo City | 2013 – 2017 CERTIFICATIONS • HIPAA Compliance Training • Healthcare Data Privacy & Security