John Jepsane

Medical billing and revenue cycle professional with more than five years of experience supporting U.S. healthcare accounts across accounts receivable, insurance verification, provider services, claim follow-up, denial resolution, appeals, and quality assurance. Demonstrated ability to analyze EOBs, payer policies, payment details, and claim documentation to determine root causes of denials, underpayments, and reimbursement delays. Recognized for accurate HIPAA-compliant documentation, organized follow-up, process auditing, SOP development, and clear communication with providers, payers, operations teams, and client stakeholders.

Medical Biller at PEDIATRIC PRACTICE - ALABAMA, U.S. (2026-04 – 2026-08)

• Prepared and billed pediatric claims by reviewing patient, provider, payer, diagnosis, procedure, and service information for completeness and billing readiness before submission.
• Generated CMS-1500/837 claim files and completed required post-billing claim updates according to established clinic and payer workflows.
• Reviewed claim setup and billing details, corrected workflow issues before submission, and followed payer-specific requirements to reduce preventable rejections and delays.
• Supported Medicaid-related pediatric billing workflows, including payer-specific claim handling and required post-submission documentation steps under clinic SOPs.
• Maintained accurate billing notes and claim activity documentation to support follow-up, continuity, and compliant revenue cycle operations.

Quality Analyst at OPTUM GLOBAL SOLUTIONS (2024-10 – 2026-02)

• Conducted quality audits across U.S. healthcare operations to evaluate billing-related accuracy, documentation quality, compliance, and adherence to client and company standards.
• Identified workflow gaps, recurring errors, and documentation deficiencies, then recommended corrective actions to strengthen process accuracy and operational performance.
• Analyzed quality trends and performance results across multiple client accounts to provide actionable feedback and support consistent service delivery.
• Collaborated with operations teams, client stakeholders, and internal departments to align audit expectations, clarify process requirements, and improve quality outcomes.
• Developed SOPs, audit guidelines, measurement tools, and process references to standardize workflows and improve team consistency.
• Designed organized quality workflows for new client processes, making performance measurement, monitoring, and reporting more structured and efficient.

Senior Collection Representative at OPTUM GLOBAL SOLUTIONS (2021-07 – 2024-09)

• Managed healthcare accounts receivable follow-up and claim resolution activities for U.S. healthcare accounts, focusing on unpaid, denied, underpaid, and aging balances.
• Analyzed EOBs, payer policies, claim history, payment information, and supporting documentation to identify denial causes and reimbursement barriers.
• Resolved claim issues by determining the appropriate correction, appeal, payer follow-up, documentation request, or escalation pathway.
• Prepared and submitted appeal documentation, corrected claim information, and follow-up requests to support timely claim reconsideration and reimbursement.
• Contacted insurance payers and reviewed claim status information to verify processing outcomes, payment details, denial reasons, and required next steps.
• Handled special end-to-end aging claim projects by organizing account research, documenting actions, tracking follow-up dates, and maintaining resolution visibility.
• Maintained complete and accurate account notes in healthcare systems to support continuity, audit readiness, HIPAA compliance, and efficient follow-up.
• Recommended SOP and workflow improvements after identifying process gaps, recurring claim issues, and opportunities to simplify resolution steps.

Provider Contact Center Representative at CONDUENT PHILIPPINES (2019-05 – 2020-08)

• Handled provider inquiries for U.S. healthcare accounts involving eligibility, benefits, claim status, payment information, denial reasons, appeals, and billing concerns.
• Verified insurance eligibility and benefits by reviewing payer information, patient coverage, plan details, and account records.
• Researched claims and billing concerns to explain processing status, payment outcomes, denial causes, and required provider actions.
• Assisted providers with appeal documentation, claim submission requirements, and payer process guidance to support claim resolution.
• Processed provider requests and website inquiries through Availity and other healthcare-related platforms while maintaining accurate documentation.
• Communicated claim and coverage information clearly and professionally to support provider satisfaction and operational efficiency.

Bachelor of Secondary Education in Major in Mathematics – Cavite West Point College (2019)