Rosell Pelandi

Rosell G. Pelandi Norzagaray, Bulacan, Philippines Contact no. (- Skype ID: rosellpelandi25 Email Add.- WORK EXPERIENCE Virtual Assistant – Insurance Verification Kentucky Counseling Center December 2020 – July 2022 • Checking member's eligibility and benefits for mental health coverage for scheduled patients. • Making sure that all active insurance and billing payments are accurately uploaded in the system. • Email and let the lead admin know about any discrepancy regarding client’s insurance. Patient Account Representative I (Healthcare Account) Conifer Global Business Center Inc. June 2020 – November 2020 • Verify claims adjudication utilizing appropriate resources and applications. • Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers. • Edit claims to meet and satisfy billing compliance guidelines for electronic submission. • Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory. Patient Services Representative I (Healthcare Account) Classic Sleepcare IT Services June 2018 – February 2020 ● Proper categorization of patient’s data/documents separating new business and established. ● Received Setup Form (specifically CPAP machines and supplies) from patient and able to enter it in the system. ● Accurately input and track in the database systems the sale orders throughout the process. ● Verifying patient’s benefits and eligibility thru their insurances. Sr. Underwriter Processor (Auto Insurance) Ammex I-Support International Corporation July 2015 – January 2018 ● Assessing background information on the client ● Studying insurance proposals ● Underwrite policies if submitted documents meet the criteria per underwriting guidelines of the insurance company, including the rules and restrictions of each using a software program. ● Remove credit card information of the insured if no payment, still no documents received and/or per insured’s requests. ● Keeping detailed and accurate records of policies underwritten and decisions made. ● Verifying process to onshore counterpart when complex scenarios were encountered Transaction Processing Representative (Healthcare Insurance) Accenture Inc. May 2010 – July 2015 ● More specifically, the primary role is to review completeness and accuracy of insurance claims to ensure that healthcare policy guidelines are followed prior to authorizing payment or filing a request for a medical review. ● Perform data entry and research in various systems and tracking tools. ● Research and review the overpayment refunds; validate and processed claims accordingly based on the standard procedure in the adjustment of claims or recovers the refund/dollar amount ● Individual contributor as a part of a team, with a focused scope of work. ● Take initiative to review audit trends, service level feedback, or client updates and must be able to produce work outputs that would meet and surpass client specified SLAs ● Communicate with the Quality Auditor to have a calibrated knowledge with the onshore part. ● Do some Adhoc Task. EDUCATIONAL BACKGROUND Bachelor of Science in Business Administration Major in Computer Management Interface Computer College June 2005 - April 2009 Macario B. Asistio Sr. High School June 2001 – March 2005 CHARACTER REFERRENCE Micah Avenido- Julie May Lopez- Erlyn Mantaring-