Maria Kirsten Villarojo
Medical Claims Specialist
Mandaluyong
Summary
Medical Claims Specialist with solid background in medical claims processing, adept at resolving claim disputes and reducing outstanding balance through meticulous investigations and effective communication with insurance carriers. Extensive experience in medical claims processing and resolution. Proven track record of efficiently handling claims, resolving discrepancies, and maintaining compliance. Known for strong team collaboration, adaptability, and commitment to achieving results.
Overview
10
10
years of professional experience
3
3
Languages
Work History
Medical Claims Specialist
Intelassist
08.2024 - 07.2025
- Proactively investigate the reasons behind claim denials and analyze the information gathered and communicate with payers for the status of claims
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posted payments to accounts and maintained records.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Generated, posted and attached information to claim files.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
Medical Claims Specialist
KMC
05.2023 - 06.2024
- Effectively resolved claim disputes by conducting thorough investigations and analyze the information gathered
- Followed up on denied claims to verify timely patient payment and resolution and communicate with payers for claims status
- Resubmitted claims after editing or denial to achieve financial targets
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
Medical Claims Analyst/Payment Poster
Med-Metrix
06.2019 - 05.2023
- Effectively resolved claim disputes by conducting thorough investigations and analyze the information gathered
- Followed up on denied claims to verify timely patient payment and resolution and communicate with payers for claims status
- Resubmitted claims after editing or denial to achieve financial targets
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
- Posted payments to accounts and maintained records.
- Utilized Microsoft Excel, and QuickBooks to manage invoices and payments.
Accounts Receivable Specialist
GeBBS
03.2019 - 06.2019
- Effectively resolved claim disputes by conducting thorough investigations and analyze the information gathered
- Followed up on denied claims to verify timely patient payment and resolution and communicate with payers for claims status
- Resubmitted claims after editing or denial to achieve financial targets
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
HR Service Advisor
Sitel
08.2017 - 03.2019
- Managed large amount of incoming calls from Members in checking and enrollment of medical and dental benefits, payroll and tax inquiries, savings and checking accounts.
- Maintained patient/member records and statistical data to establish accuracy and compliance with applicable regulations.
Provider Claims Advisor
Hinduja Global Solutions, HGS
03.2015 - 05.2017
- Managed large amount of incoming calls from providers and/ or facility/hospitals checking for the status of claims and appeals and also escalate issues to appropriate department for final resolution.
- Perform back office drafting/creating appeals and medical records attachment to submit to insurance careers in order to reconsider a denial and/or dispute an appeal determination
Education
Bachelor of Science - Information Technology
University of Cebu
Cebu City 05.2001 -
Skills
Claims processing
Insurance verification
Medical coding
Medical billing
Payment posting
EOB analysis
Claim denials management
Claims investigation
Medical record review
Electronic health records (EHR)
Insurance claims processing
Skilled in Medical billing software[Epic, Kohezion, Valant, Waystar]
Microsoft office
Time management
Multitasking
Interpersonal skills
Timeline
Medical Claims Specialist
Intelassist
08.2024 - 07.2025
Medical Claims Specialist
KMC
05.2023 - 06.2024
Medical Claims Analyst/Payment Poster
Med-Metrix
06.2019 - 05.2023
Accounts Receivable Specialist
GeBBS
03.2019 - 06.2019
HR Service Advisor
Sitel
08.2017 - 03.2019
Provider Claims Advisor
Hinduja Global Solutions, HGS
03.2015 - 05.2017
Bachelor of Science - Information Technology
University of Cebu
05.2001 -
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