Clayford Cadiente

Managed and updated patient medical histories, schedules, and eligibility information across multiple EHR systems, including OptumPro Portal, eClinicalWorks, and CURES. Transferred, verified, and organized lab results and prescription documents for streamlined clinical operations. Transcribed and summarized prescription documents and reviewed prior patient encounters to ensure proper medication continuation.

Medical Virtual Assistant - My Mountain Mover - Remote

(2025-07 - 2026-06)

• Managed and updated patient medical histories, schedules, and eligibility information across multiple EHR systems, including OptumPro Portal, eClinicalWorks, and CURES.
• Transferred, verified, and organized lab results and prescription documents for streamlined clinical operations.
• Transcribed and summarized prescription documents and reviewed prior patient encounters to ensure proper medication continuation.
• Processed controlled prescriptions in strict compliance with CURES regulations.
• Submitted prior authorization requests for prescription medications on behalf of patients to insurance providers, ensuring all required documentation was complete and accurate.
• Pulled, logged, and returned patient and prescription-related phone voicemails to maintain consistent communication flow.
• Created future orders for patient appointments and clinical assessments.
• Managed medical records release, patient invoicing, and follow-up for payments.
• Maintained strict HIPAA compliance and confidentiality while handling sensitive patient information.
• Checked the patient's eligibility and benefits through the payer portal.

Senior Process Executive - Cognizant Technology Solutions Philippines Inc. - Remote

(2023-10 - 2025-05)

• Handled U.S. healthcare provider calls related to Medicare, Medicaid, and commercial insurance, offering support on various policy, claim, and plan matters.
• Assisted with eligibility and benefits, prior authorizations, claims status, and appeal processes.
• Ensured accurate information recording while maintaining compliance with healthcare regulations and delivering professional, solution-focused support.

Customer Service Representative - EXL Services Philippines - Remote

(2020-09 - 2023-09)

• Managed inbound calls as a front-line operator for a US life insurance provider, assisting callers with general inquiries and routing them to the appropriate departments.
• Provided accurate information on policy status, premium payments, and basic account details, ensuring a highly satisfactory customer experience.
• Maintained clear call documentation and demonstrated effective communication in a high-volume environment.

Member Services - Alorica Inc. - Cubao, Quezon City

(2019-11 - 2020-06)

• Responded to calls for senior citizens and ESDRD enrollees in Medicare Part D and Part A/B, assisting with prescription drug coverage.
• Addressed or escalated issues regarding claims, eligibility, prior authorizations, plan inquiries, and authorization submission requests.
• Delivered exceptional customer service tailored to the needs of vulnerable populations, while managing multiple systems to resolve issues efficiently.
• Submitted prior authorization request for prescription to the PA department on behalf of the member.

Provider Services - Concentrix CVG Inc. - Sta. Cruz, Manila

(2018-05 - 2019-10)

• Assisted dental providers with claims status, coverage verification, benefits explanation, eligibility, authorizations, network participation, and billing inquiries for PPO and HMO plans.
• Provided accurate dental claims data to the providers, utilizing multiple systems.
• Interpreted plan policies and maintained up-to-date provider records, demonstrating professional communication to enhance provider satisfaction and the efficiency of dental processes.
• Processed ERA enrollment from different dental offices, ensuring accurate and timely submission of enrollment applications and supporting documentation.

Bachelor of Science - Psychology - Far Eastern University - Manila (2023 - 2025)

Bachelor of Science - Civil Engineering - Technological Institute of the Philippines (2016 - 2018)