Jerwen Dela Torre

Dynamic and results-driven specialist with over 8 years of experience in the healthcare industry, combining deep expertise in medical billing and insurance coordination with strategic sales and marketing abilities. Adept at navigating payer policies, resolving complex claims issues, and driving software adoption through consultative selling. Passionate about streamlining operations for healthcare providers while creating meaningful client connections to support growth and profitability.

Medical Biller and Appeals Specialist - West Coast Wound and Skin Care

(2025 - 2026)

• Managed end-to-end Revenue Cycle Management (RCM) for wound care services, from charge entry through final resolution.
• Prepared, submitted, and tracked wound care claims, ensuring accuracy and compliance with payer requirements.
• Reviewed claim denials and rejections, identifying root causes and correcting/resubmitting claims in a timely manner.
• Drafted and filed first- and second-level appeals for denied wound care claims, including documentation and medical necessity justification.
• Handled Administrative Law Judge (ALJ) hearings for wound care appeals, preparing case files, evidence, and supporting documentation for hearing-level review.
• Monitored accounts receivable and followed up with payers to resolve outstanding balances and reduce aging.
• Coordinated with providers and clinical staff to gather documentation needed to support billing and appeals.
• Maintained up-to-date knowledge of payer policies, coding guidelines, and appeals procedures specific to wound care.

Senior Medical Practice Consultant - WRS Health

(2021 - 2025)

• Led end-to-end consultative sales cycles for WRS Health EMR and practice management solutions, tailoring demos to physician workflows.
• Did marketing outreach to grow provider base and drive product adoption.
• Coordinated onboarding and billing software implementation to streamline insurance claims.
• Handled Medical Billing for the billing clients and helped them reduce aging and increased practice revenue through timely claim submission.

Pharmacy Helpdesk Specialist - OptumRX Pharmacy, Inc.

(2019 - 2021)

• Resolved issues tied to pharmacy benefit claims, eligibility, and prior authorization.
• Provided step-by-step guidance to provider, helping them efficiently utilize pharmacy benefit portal.

Service Delivery Specialist / Provider Care Advocate - Anthem, Inc.

(2016 - 2019)

• Reviewed and processed complex professional and facility claims, ensuring compliance with Anthem guidelines.
• Served as point-of-contact for Sutter Medical billing operations, managing medical documents and generating reports for internal metrics.
• Delivered expert support to providers in navigating insurance policies, claims appeals, and patient benefit inquiries.

Social Media Ambassador - TTEC, Inc.

(2018 - 2021)

• Boosted brand visibility through engaging online content and targeted marketing strategies.
• Built brand awareness of TTEC through public reviews.
• Managed online reviews for TTEC.