Jexus Sangel

I’m a Healthcare Claims AR Specialist and Medical AR Specialist with 4+ years supporting US healthcare revenue cycle operations. I focus on denied, underpaid, unpaid, and aging receivables to help providers get timely reimbursement and complete account resolution.

In my current role, I manage 45+ medical claim accounts daily, reviewing patient accounts, claim history, payer responses, and supporting billing notes. I use Epic Hyperspace, Availity, EHR/EMR systems, payer portals, and internal billing/CRM tools to analyze EOB/ERA details and identify root causes such as eligibility issues, authorization gaps, coding/modifier concerns, missing information, timely filing problems, and payer-specific requirements.

When claims don’t pay correctly, I drive the workflow through payer follow-ups by phone and online portals with Medicare, Medicaid, and commercial insurance representatives. I prepare and submit appeals, reconsiderations, corrected claims, and claim resubmissions with HIPAA-compliant documentation, and I escalate unresolved issues to support recovery of reimbursement.

I’m also trusted for authorization-related denials: I review case details, gather required information, check payer guidelines, and submit retro authorization requests through insurance portals when applicable. I track next steps with follow-up dates and resolution outcomes, keeping clear audit-ready notes and confidential patient information handling throughout.