Raven
Healthcare Specialist
Talent
Quezon, Metro ManilaMember since July 19, 2026
Looking for a jobAuthorization Management
·
Hire this person
Send a job offer directly to this candidate
Looking for a jobAuthorization Management
About
Schedules patient appointments for hospitals in Michigan
Experience
Senior Associate - R1 RCM
(2024-06)
- Schedules patient appointments for hospitals in Michigan
Medical Records Specialist - Emapta
(2023-12 - 2024-04)
- Verify insurance funding type to determine arbitration level (state or federal)
Healthcare Executive - Team Lead - Omega Healthcare
(2022-07 - 2023-10)
- Complete tasks within the scope of Authorization Management for Radiology, Surgical, Pain management orders, etc
- Lead team members upon promotion
Outbound Customer Advocate - Medrisk, LLC
(2021-10 - 2022-06)
- Manage and monitor worker's compensation case status by confirming patient attendance and obtaining treatment notes from network providers, and addressing any concerns regarding compliance
- Update all case related data to the company's database/platform
- Track and relay authorization to our providers
Case Management Specialist - Team Lead - Ista Solutions
(2020-11 - 2021-08)
Job Objective: Ensure SNF patients have authorizations in place for their inpatient stay
- Handled more than 30 facilities after team lead promotion
- Conduct verbal concurrent reviews
- Handled inbound, outbound calls, faxes and emails
- Trained newly hired specialists, proofread emails of new hires before emails are sent to payers and providers
- Address teams members' and client's concerns
- Attend meetings with clients regarding updates
Utilization Management Reviewer - Access Healthcare
(2019-06 - 2020-06)
- UM Reviewer for a Medicare Advantage Insurance Company
- Reviews medical records sent by providers and determine medical necessity using Interqual and based on Medicare guidelines
Education
Bachelor of Science - Physical Therapy - Manila Adventist Medical Center and Colleges (2013 - 2018)
Skills
Healthcare Specialist
