Deverlyn Macasadia

Detail-oriented healthcare support professional with over 6 years of experience in provider services, benefits verification, claims processing, prior authorization, appeals, claim review, and healthcare administration. Skilled in handling confidential information, maintaining accurate records, and supporting healthcare providers through efficient communication and problem resolution. Seeking to leverage extensive healthcare operations experience in a Medical Virtual Assistant role.

Provider Service Advocate – Chat Operations - Optum Global Solutions

(2023-01)

• Assist healthcare providers with benefits and eligibility verification through chat support.
• Process claim status inquiries, appeals, disputes, and reconsideration requests.
• Support prior authorization requirements and Coordination of Benefits (COB) verification.
• Provide credentialing assistance and provider-related administrative support.
• Maintain accurate documentation while ensuring HIPAA compliance.
• Deliver timely and professional resolutions to healthcare provider concerns.

Operations Specialist / Escalation Specialist - ResultsCX - Lipa City, Batangas

(2018-08 - 2022-12)

• Handled provider inquiries regarding member benefits, eligibility verification, and claim status.
• Investigated escalated claim issues and performed detailed claim reviews to determine whether claims were processed correctly according to plan guidelines and policies.
• Identified incorrectly denied or processed claims and facilitated appropriate claim adjustments and corrections.
• Processed appeals, disputes, and reconsideration requests while ensuring compliance with healthcare policies and procedures.
• Coordinated Coordination of Benefits (COB) verification and prior authorization requirements.
• Maintained accurate documentation and provider records with strong attention to detail.
• Collaborated with internal departments to resolve complex claim and billing issues.

High School Graduate