Mariane Bautista

I am a provider relations advocate with over five years of experience resolving medical and dental claims, managing provider inquiries, and guiding appeals and grievances to resolution. I consistently deliver timely, accurate, and courteous responses to high volumes of provider calls and correspondence.

My hands-on experience includes eligibility and benefits verification, claim denial analysis, recoupment coordination with third-party vendors, and re-processing claims when required. I am proficient with CPT/HCPC/ICD-10 coding checks, authorization requirements, and applying LCD/NCD/OCE/NCCI guidelines to ensure correct billing.

I collaborate effectively with operations, business partners, and internal departments to expedite complex inquiries and escalate when necessary. I maintain strong KPI performance (AHT, NPS, productivity, and quality) and am comfortable using multiple CRM and claims tools to support provider services.