Arce Mae

Dedicated Insurance Verification Specialist with strong experience verifying patient insurance eligibility, reviewing benefits, coverage, and policy limitations using different payer portals, and ensuring accurate documentation of verification results through EHR. Skilled in communicating insurance information clearly to patients, providers, and healthcare staff while maintaining confidentiality and HIPAA compliance. Detail-oriented, organized, and committed to supporting efficient patient access, minimizing claim denials, and delivering exceptional customer service in fast-paced healthcare environments.

Patient Care Coordinator (End-to-End Revenue Cycle Management) at OPTUM GLOBAL SOLUTIONS (2024-03 – Present)

• Performed insurance eligibility and benefits verification, including coverage details, copays, deductibles, coinsurance, and prior authorization requirements for commercial, Medicare, and Medicaid payers.
• Managed and updated patient demographics, insurance information, authorization records, and billing data within Electronic Health Record (EHR) and practice management systems while ensuring HIPAA compliance and data accuracy.
• Navigated payer portals to verify benefits, check claim status, review authorization requirements, and create/manage secure login access to support efficient insurance verification workflows.
• Documented verification activities, resolved coverage discrepancies with payers and providers, prevented claim delays, and consistently achieved 150% productivity goals while maintaining quality standards.

Professional Billing Representative at OPTUM GLOBAL SOLUTIONS (2023-03 – 2024-03)

• Verified and explained patient billing statements, EOBs, and denial documents with patient's eligibility and benefits resolving discrepancies related to office visits, preventive services, and claim payments while documenting cases in CRM and EHR systems.
• Manage at least 55 inbound calls a day, processed payments, established payment plans, monitored outstanding balances, and initiated collection activities while maintaining positive patient relationships and HIPAA compliance.
• Assisted with insurance claim resolution by reviewing authorization requirements and coordinating with providers on accurate claim submissions, including NPI, Tax ID, claims address, and payer guidelines.

Pharmacy Helpdesk Specialist (Contractual Employment) at OPTUM GLOBAL SOLUTIONS (2022-11 – 2023-03)

• Verified patient insurance eligibility, benefits, prior authorizations, and refill overrides for commercial, Medicare, and Medicaid plans while maintaining accurate records in EHR and pharmacy systems.
• Processed refill overrides and prior authorizations by coordinating with insurers, pharmacies, and prescribers, ensuring timely medication access and HIPAA compliance.
• Documented insurance verification, claim resolutions, and patient interactions while managing high-volume calls - at most 135 inbound calls a day; and consistently meeting quality, productivity, and SLA targets.

Bachelor of Secondary Education in English – Southern Leyte State University - San Juan Campus (2014-06 – 2018-04)

Coursework in Virtual Assistant Academy Pro