Marc Lester Maderazo
Taguig, Philippines
Marc Lester Maderazo
US Medical Claims & RCM Specialist | Specialty Bio
Category : Pharmacy and medication
I am a detail-oriented Medical Billing & RCM Specialist with over 5 years of hands-on experience navigating the US healthcare claims lifecycle. My expertise spans front-to-back revenue cycle management, specializing in accurate charge entry, insurance verification, and denial resolution for high-cost specialty therapies.
Having worked extensively within Asthma & Immunology care, I am highly adept at handling complex data management and billing workflows for specialty biologics like Xolair, Dupixent, Tezspire, Nucala, and Fasenra. I pride myself on maintaining a high standard of accuracy, navigating payer portals efficiently, and keeping operations strictly HIPAA compliant.
I work effectively as an independent remote asset or as a collaborative partner alongside clinic providers and office staff to protect revenue and streamline workflows.
Core Competencies & Tech Stack:
RCM Specialties: Full-Cycle Medical Billing, Claims Tracking, Demographics & Eligibility Verification, Payment Posting, Denial Resolution.
EHR/EMR Systems: athenahealth, eClinicalWorks, CollaborateMD, PointClickCare.
Primary Portals: Availity, Navinet, Payspan, Cigna, BCBS, Medicare Palmetto, and Specialty Co-pay Portals.
Having worked extensively within Asthma & Immunology care, I am highly adept at handling complex data management and billing workflows for specialty biologics like Xolair, Dupixent, Tezspire, Nucala, and Fasenra. I pride myself on maintaining a high standard of accuracy, navigating payer portals efficiently, and keeping operations strictly HIPAA compliant.
I work effectively as an independent remote asset or as a collaborative partner alongside clinic providers and office staff to protect revenue and streamline workflows.
Core Competencies & Tech Stack:
RCM Specialties: Full-Cycle Medical Billing, Claims Tracking, Demographics & Eligibility Verification, Payment Posting, Denial Resolution.
EHR/EMR Systems: athenahealth, eClinicalWorks, CollaborateMD, PointClickCare.
Primary Portals: Availity, Navinet, Payspan, Cigna, BCBS, Medicare Palmetto, and Specialty Co-pay Portals.
Working hours
- Monday:08h00 To 18h00
- Tuesday:08h00 To 18h00
- Wednesday:08h00 To 18h00
- Thursday:08h00 To 18h00
- Friday:08h00 To 18h00
- Saturday:Not available
- Sunday:Not available
![US Medical Claims & RCM Specialist | Specialty Biologics | AP & AR]()
I am a detail-oriented Medical Billing & RCM Specialist with over 5 years of hands-on experience navigating the US healthcare claims lifecycle. My expertise spans front-to-back revenue cycle ...
• Managed precise billing workflows and documentation review for high-cost therapies within Asthma & Immunology Care (including Xolair, Dupixent, Tezspire, Nucala, and Fasenra)
• Performed front-to-back revenue cycle management and medical claims processing, including insurance eligibility, benefits verification, charge entry, claim follow ups and initial denial resolution.
• Executed accurate payment posting, reconciliation assistance, and daily accounts payable tasks to maintain balanced provider ledgers.
• Conducted clinical documentation reviews and data entry management across multiple electronic health record (EHR) and billing systems.
• Coordinated with providers, office staff and insurance payers to resolve billing discrepancies.
• Maintained strict compliance with HIPAA Privacy and Security requirements using virtual data security protocols.
• Proficient in utilizing electronic health record (EHR) system, Athena Health, Collaborate MD
and eClinicalWorks
Tools: Outlook, Google Sheets, Ring Central and Private Internet Access
Portals: Availity, Boulder, BCBS, Cigna, Xolair, Tezspire, Nucala, Fasenra Copay portals,
Medicare Palmetto VA, CO, Medicaid VA, Navinet etc
• Performed front-to-back revenue cycle management and medical claims processing, including insurance eligibility, benefits verification, charge entry, claim follow ups and initial denial resolution.
• Executed accurate payment posting, reconciliation assistance, and daily accounts payable tasks to maintain balanced provider ledgers.
• Conducted clinical documentation reviews and data entry management across multiple electronic health record (EHR) and billing systems.
• Coordinated with providers, office staff and insurance payers to resolve billing discrepancies.
• Maintained strict compliance with HIPAA Privacy and Security requirements using virtual data security protocols.
• Proficient in utilizing electronic health record (EHR) system, Athena Health, Collaborate MD
and eClinicalWorks
Tools: Outlook, Google Sheets, Ring Central and Private Internet Access
Portals: Availity, Boulder, BCBS, Cigna, Xolair, Tezspire, Nucala, Fasenra Copay portals,
Medicare Palmetto VA, CO, Medicaid VA, Navinet etc
Perform claims tracking duties, patient eligibility, denial clarification by coordinating with
insurance companies and requesting EOB/EOP if needed.
Utilize electronic health record (EHR) system to accurately verify patient information, claim
and appeal submission and documenting claim status.
Proficient in utilizing electronic health record (EHR) system, PointClickCare.
Tools: AR Pro, Jivetel, Google Sheets. Portals: Availity, NGS Medicare, CountyCare, Meridian.
insurance companies and requesting EOB/EOP if needed.
Utilize electronic health record (EHR) system to accurately verify patient information, claim
and appeal submission and documenting claim status.
Proficient in utilizing electronic health record (EHR) system, PointClickCare.
Tools: AR Pro, Jivetel, Google Sheets. Portals: Availity, NGS Medicare, CountyCare, Meridian.
• Calling insurances for claim and appeal status, patient eligibility and benefits.
• Payment posting from payor websites such as Payspan, Availity, Magnacare, Allied Benefit System
and Tricare to the EHR(Athena Health).
• Uploading supporting documents like updated w9, medical records, primary EOB/ERA if already on
the system and send request if not, for resubmission.
• Notating payor suggestion and correct the info that needs correction and kicking it with proper
kick-code to have it transferred to the correct department for faster processing.
• Understanding the claim denial reason and calling insurance if the problem can be resolved over
the phone and avoid unnecessary resubmission, i.e. authorization number, timely filing limit,
COB, and incorrect denial with previous payments to back it up.
• Payment posting from payor websites such as Payspan, Availity, Magnacare, Allied Benefit System
and Tricare to the EHR(Athena Health).
• Uploading supporting documents like updated w9, medical records, primary EOB/ERA if already on
the system and send request if not, for resubmission.
• Notating payor suggestion and correct the info that needs correction and kicking it with proper
kick-code to have it transferred to the correct department for faster processing.
• Understanding the claim denial reason and calling insurance if the problem can be resolved over
the phone and avoid unnecessary resubmission, i.e. authorization number, timely filing limit,
COB, and incorrect denial with previous payments to back it up.
• Answering high volume of calls in a timely manner (inquiries, sales, account billing, technical support and mainly for activation)
• Meet/Exceed the needed percentage/number to pass our (Conversion, CSAT and AHT) monthly goal.
• Give the best applicable solution in a courteous and straightforward manner to ensure the members satisfaction.
• Meet/Exceed the needed percentage/number to pass our (Conversion, CSAT and AHT) monthly goal.
• Give the best applicable solution in a courteous and straightforward manner to ensure the members satisfaction.
• Answering high volume of calls in a timely manner (inquiries, sing-up, account billing, technical support) and give the best applicable solution.
• Handle the customer complaints in a clean, courteous, and in a straightforward manner.
• Meet/Exceed the needed percentage/numbers to pass our (conversion, retention, average handling time) monthly goal.
• Documenting the customer’s issues from the first point of contact to resolution.
• Handle the customer complaints in a clean, courteous, and in a straightforward manner.
• Meet/Exceed the needed percentage/numbers to pass our (conversion, retention, average handling time) monthly goal.
• Documenting the customer’s issues from the first point of contact to resolution.
• Diligently conducted more than 300 calls per day and have always stuck to the quality guidelines.
• Constantly hitting or exceeding our monthly goal.
• Handled calls in a fast pace to open up more opportunities for sale.
• Constantly hitting or exceeding our monthly goal.
• Handled calls in a fast pace to open up more opportunities for sale.
- 🇬🇧 English
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