Open to opportunities

Rachel Ann Santiago

@rachelannsantiago

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Experienced medical claims examiner skilled in claims adjudication, quality assurance, and outpatient processing.

Philippines

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What I'm looking for

I seek a role in medical coding/claims where I can apply adjudication and QA skills, contribute to process improvements, and work in a professional, team-oriented environment.

I am a detail-oriented medical claims professional with experience in claims adjudication, quality assurance, and outpatient claims processing across multiple lines of business including Commercial, PPO, POS, and Medicare.

From 2018 to 2024 I worked in roles that required accurate data entry, eligibility verification, denial processing, turnaround-time management, root-cause analysis, and quality tracking to improve team performance and claims accuracy.

I am people-oriented, hardworking, persistent and able to work under pressure, and I seek to leverage my pharmacy education and hands-on claims experience to support an outsourced medical facility's coding and claims operations.

Experience

Work history, roles, and key accomplishments

Medical Claims Examiner

Imagenet Philippines Inc.

Dec 2021 - Sep 2024 (2 years 9 months)

Reviewed and adjudicated professional and institutional claims across multiple lines of business, ensuring payment/denial accuracy and adherence to regulatory and client guidelines; investigated eligibility and authorizations to maintain turnaround targets.

Medical Billing Regulatory Compliance Denial Management QA

Quality Assurance Specialist

Equicom Information Technology, Inc.

Sep 2019 - Mar 2021 (1 year 6 months)

Monitored and analyzed claims quality and team performance, produced reports, conducted root-cause analyses, and implemented action plans to improve accuracy and meet project SLAs.

Quality Assurance Data Analysis Reporting Root Cause Analysis Performance Tracking Process Improvement SLA Management

Outpatient Claims Processor

Equicom Information Technology, Inc.

Mar 2018 - Sep 2019 (1 year 6 months)

Evaluated and adjudicated outpatient claims to meet daily/weekly targets, ensured claim quality, prioritized batches by TAT and aging, and escalated system or scanning issues to supervisors.

Outpatient Claims Adjudication System Prioritization Quality Control TAT Management Medical Billing