Mary Julia An
Medical Reimbursement Claims Adjudicator at NAS Administration Services- Claim this Profile
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English -
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Tagalog -
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Arabic -
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Chinese (Traditional) -
Topline Score
Bio
Credentials
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Medical Transcription NC II
TESDA -
Nursing Licensure Exam
Professional Regulatory Commission
Experience
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NAS Administration Services
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United Arab Emirates
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Insurance
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200 - 300 Employee
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Medical Reimbursement Claims Adjudicator
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Mar 2014 - Present
• Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements • Taking a Lead Role in assuring that the assigned tasks to the team are completed within the allocated time frame • Entered claims data into system • Resolved problems resulting from claim settlement • Performed audit of randomly selected claims to ensure quality processing • Researches claim overpayments and requests funds • Followed adjudication policies and procedures to make sure proper payment of claims • Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims • Logged telephone calls in system and followed up on issue • Monitoring and maintaining the claims processing and adjudicating cycle in NAS operational software system as per the defined terms and policy of the organization • Establishing strategies and implementing effective parameters for sling all possible queries within the team • Ensures the proper communication and implementation of new formats, training and processing rules • Entering and processing/ adjudicating claims in NAS operational software system as per the terms and policy of the organization • Maintaining both qualitative and quantitative claims measures Show less
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The Health Medical Services
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Al Ain, Abu Dhabi, UAE
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Homecare Nurse
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Mar 2013 - Nov 2013
• Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements • Taking a Lead Role in assuring that the assigned tasks to the team are completed within the allocated time frame • Entered claims data into system • Resolved problems resulting from claim settlement • Performed audit of randomly selected claims to ensure quality processing • Researches claim overpayments and requests funds • Followed adjudication policies and procedures to make sure proper payment of claims • Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims • Logged telephone calls in system and followed up on issue • Monitoring and maintaining the claims processing and adjudicating cycle in NAS operational software system as per the defined terms and policy of the organization • Establishing strategies and implementing effective parameters for sling all possible queries within the team • Ensures the proper communication and implementation of new formats, training and processing rules • Entering and processing/ adjudicating claims in NAS operational software system as per the terms and policy of the organization • Maintaining both qualitative and quantitative claims measures Show less
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Provincial Health Office
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Camarines Sur, Philippines
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Staff Nurse
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Oct 2012 - Mar 2013
•Identifies patient care requirements by establishing personal rapport with potential and actual patients and other persons in a position to understand care requirements •Establishes a compassionate environment by providing emotional, psychological, and spiritual support to patients, friends, and families •Resolves patient problems and needs by utilizing multidisciplinary team strategies •Maintains safe and clean working environment by complying with procedures, rules, and regulations; calling for assistance from health care support personnel •Documents patient care services by charting in patient and department records •Maintains continuity among nursing teams by documenting and communicating actions, irregularities, and continuing needs Show less
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Isarog Family Health Care and Training Center
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Naga City, Philippines
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Staff Nurse
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Jul 2012 - Oct 2012
•Assesses the condition of mothers during their pregnancy, labor, and after birth. •Responsible for the delivery of the mother, ensuring the safety of both mother and child •Assists the pregnant mothers on their laboring condition •Monitors and examines pregnant mothers •Gives advice and information to the pregnant mothers regarding their condition •Makes diagnosis and assessment about the mother’s condition and will refer to obstetricians and other specialist if abnormality occur. •Assesses if the mother is in high risk of pregnancy. •Advises the mother on proper care of the child including breastfeeding Show less
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Education
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2008 - 2012
Unibersidad de Sta. Isabel
Bachelor’s Degree, Registered Nursing/Registered Nurse -
2004 - 2008
Saint Joseph School
High School, High School/Secondary Diplomas and Certificates
Community
