Marry Jon Sareno

marryjon4354@gmail.com

+639276829411

PH

Bachelor Degree

Jose Rizal University

BS in Nursing

2008

Graduated

Access Healthcare

Client Partner Pre-certification Specialist

01/07/22

21/01/2025

Responsible in research available documentation including authorization, referral, medical and nursing notes, medical documentation on client’s system, prior to making the call. Referral Specialist July 2022 - May 2023 • Process referral records and patient information • Responsible for ensuring that patients have access to other specialty healthcare providers under their insurance. • Coordinate across medical departments. • Gather relevant information from insurance carriers and patients • Organize medical files and referrals • Enter data into an information and authorization system • Contact referring physicians for additional information as needed. • Receives and documents patients referral. • Complete tasks as assigned to ensure that all information required for a patient admission is complete. Pre-certification Specialist July 2023 - January 2025 • Verify Physicians signature and research faxed information from referring physicians’ office for precertification forms. • Initiate precert process via phone and document accordingly. • Follow up on precerts that are put in review status- Ask for any additional information necessary for obtaining pre-certification. • Notify referring physician office via fax of precert approval and patient scheduled exam date and time. • Notify referring physician office of any denials. • Update schedule list daily for CT, MRI, and PET –verify all patients scheduled have precert authorizations and that the numbers are entered into the RIS system along with expiration date of authorization and date of service rendered. • Obtain precerts for any other insurance with which The Radiology Clinic participates. • Responsible for updating authorizations. • Review Medical provider and nursing notes of patients medical history related to the order task assigned. • Other duties as assigned.

Alorica Inc,

Provider Customer Service Representative

01/10/2013

01/07/2023

Eligibility Verification • Communicates with insurance eligibility and their type of plan coverage to providers to obtain necessary information and resolve issues related to insurance coverage Benefit Verification • Assist provider to patients insurance-related inquiries and explain coverage details. • Responsible for verifying patient insurance coverage accurately • Communicate with insurance companies to obtain benefit updated information. Claims Verification • Ensure that claims are processed correctly and timely • Handle denials and appeals • Process and review medical claims • Investigate and resolve discrepancies in medical claims • Identify errors in medical coding and billing • Analyzing medical claims data and resolving medical billing issues. • Ability to review medical documentation • Proficiency with medical insurance and payment processes. Others • Maintain patient confidentiality and adhere to HIPAA regulations.

Customer Relationship Management (CRM)