Jefferson Nabaunag

Performed accurate CPT and ICD-10 charge entry and reconciled patient encounters daily, completing charge entries within 1–2 days and maintaining high accuracy to meet productivity and compliance targets.

Initiated and managed prior authorizations for durable medical equipment, verified insurance benefits, maintained EMR records, and followed up to resolve delays or denials to ensure timely authorization outcomes.

Managed payer denials by procuring records, performing analytic clinical reviews, and developing evidence-based appeals to recover underpaid or denied claims, improving reimbursement outcomes.

Submitted and corrected medical claims per payer guidelines, researched rejections, escalated stalled claims, and pursued appeals to ensure accurate payment and accounts receivable collection for assigned clients.

Served as SME for Blue Cross Blue Shield of Rhode Island, resolving provider billing and claims issues, educating providers on eligibility/benefits, and improving customer satisfaction through escalations and training.

Handled escalation calls for Blue Shield 65 Plus, resolving complex provider claims and appeals, redirecting issues appropriately, and contributing to team activities to enhance customer satisfaction.

Provided customer support for Smart and Sun Cellular, resolving customer requests per company policies and escalating issues to team leads to meet service expectations.

Scheduled and dispatched trucks, coordinated drivers and clients, monitored vehicle performance and fuel usage, and resolved logistical challenges to ensure timely deliveries and regulatory compliance.

Completed tertiary information technology studies at Informatics in Valenzuela City from June 2011 to October 2013.

Completed secondary education at Karuhatan High School in Valenzuela City from June 2002 to March 2006.