JEJayson Estonanto
@jaysonestonanto
Experienced healthcare appeals and AR billing specialist with 6+ years in BPO healthcare operations.
PhilippinesWhat I'm looking for
I am a healthcare appeals and accounts receivable specialist with over six years of experience in BPO settings supporting US healthcare payers and providers. I focus on Level 1 and Level 2 appeals, claims review, AR billing plans, and timely resolution of account issues.
In my recent role I processed and reviewed Level 1 and 2 appeals for Medicare Advantage accounts, determined timely filing limits, coordinated with claims and medical departments, created Jira tickets for reprocessing, and issued decision letters to providers.
I have experience using EPIC for bill tracking, CHAMP for notes and follow-up actions, ClaimsXten for coding validation, and Stand Alone Network Pricer for claims pricing. I routinely request EOBs and denial documentation and communicate with carriers to move accounts toward closure.
I bring a strong attention to detail, consistent follow-through on account resolution, and practical training in virtual assisting and Amazon VA tasks that complement my healthcare operations background.
Experience
Work history, roles, and key accomplishments
Appeals Coordinator
UST Global, Inc.
Feb 2024 - Present (1 year 10 months)
Process and review Level 1 and 2 Medicare Advantage appeals for BCBS accounts, determine timely filing limits, escalate qualifying appeals to Claims/Medical, and generate decision letters and Jira tickets to drive claim reprocessing.
AR Billing Specialist
UST Global, Inc.
Jun 2023 - Jan 2024 (7 months)
Managed AR billing workflows including follow-up calls to insurers, tracked bill status in EPIC, requested EOBs/denial letters, and posted payments to successfully close accounts.
Customer Service Representative
NTT Data Services
Aug 2021 - Jun 2022 (10 months)
Assisted Avmed members with benefits, claims, and appeals by verifying benefits, diagnosing claim coding errors, handling Medicare/Medicaid coordination, and processing appeals for reconsideration.
Customer Service Representative
Hinduja Global Solutions
Oct 2018 - Aug 2021 (2 years 10 months)
Supported Cigna provider inquiries on benefits, authorizations, claims and appeals; updated benefits/COB, reviewed authorizations, validated coding with McKesson ClaimsXten, and adjusted claim pricing using network pricers.
Education
Degrees, certifications, and relevant coursework
MFI Technological Institute
Tool and Die Technology
2012 - 2015
Completed Tool and Die Technology program at MFI Technological Institute from June 2012 to October 2015.
UDUniversity of the Philippines Diliman
Bachelor of Science, Materials Engineering
2006 - 2009
Attended the University of the Philippines Diliman campus from June 2006 to October 2009 in the BS Materials Engineering program.
Availability
Location
PhilippinesAuthorized to work in
Job categories
Interested in hiring Jayson?
You can contact Jayson and 90k+ other talented remote workers on Himalayas.
Message JaysonFind your dream job
Sign up now and join over 100,000 remote workers who receive personalized job alerts, curated job matches, and more for free!
