Jingo R.

Healthcare Operations | Technical Support | Multimedia Moderator

Medical Prior Authorization Specialist | Healthcare Operations | Technical & Customer Support Specialist | Content Moderator Professional Summary Results-driven professional with over six years of experience in healthcare operations, customer service, technical support, and quality assurance. Extensive background supporting U.S. healthcare providers, telecommunications, and insurance accounts, including UnitedHealthcare, AT&T, Verizon, and Anthem Dental. Experienced in medical prior authorization, Medicare support, provider services, customer advocacy, quality auditing, and process compliance. Demonstrated ability to resolve complex customer concerns, collaborate with healthcare providers, and maintain high-quality service standards. Promoted to Quality of Care Auditor for the UnitedHealthcare Medicare account, where responsibilities included evaluating compliance, auditing customer interactions, and ensuring adherence to healthcare regulations and company standards. Additionally, possesses accounting and administrative experience with proficiency in bookkeeping, financial documentation, cash disbursement, and office operations. Well-versed in multiple CRM platforms, accounting software, and Microsoft Office applications. Completed leadership management training and is recognized for strong communication, analytical thinking, and problem-solving abilities. Core Skills Medical Prior Authorization Healthcare Provider Support Medicare & Retirement Services Healthcare Advocacy Customer Service & Customer Experience Technical Support Quality Assurance & Auditing Content & Multimedia Moderation Bookkeeping Accounting Support Cash Disbursement Office Administration Process Improvement Leadership & Team Development Data Entry & Documentation Conflict Resolution Technical Skills QuickBooks Xero Sage Microsoft Word Microsoft Excel Microsoft PowerPoint CRM Systems Siebel Avaya Cisco Professional Experience Medical Administrative Specialist / Prior Authorization Specialist KYO Autism Therapy (Most Recent Position) Managed the end-to-end prior authorization process for Applied Behavior Analysis (ABA) therapy services, ensuring timely approvals from insurance providers. Verified patient insurance eligibility, benefits, authorizations, and coverage requirements. Prepared, submitted, tracked, and followed up on prior authorization requests with commercial insurance plans and Medicaid-managed care organizations. Coordinated with clinicians, Board Certified Behavior Analysts (BCBAs), and insurance representatives to obtain required clinical documentation. Maintained accurate patient records and documentation in accordance with HIPAA regulations and organizational policies. Communicated authorization status, denials, appeals, and renewals to internal teams and families. Assisted with scheduling, patient intake, referrals, medical records management, and other administrative duties. Ensured compliance with payer guidelines, documentation standards, and healthcare regulations. Worked collaboratively with multidisciplinary teams to improve operational efficiency and patient care. Quality of Care Auditor / Medicare & Retirement Customer Support Specialist UnitedHealthcare (Optum Global Solutions Philippines) Assisted Medicare members and healthcare providers with benefits, eligibility, claims, and healthcare services. Coordinated with providers regarding prior authorizations and member concerns. Promoted to Quality of Care Auditor responsible for monitoring call quality, compliance, and regulatory standards. Conducted quality evaluations, identified coaching opportunities, and ensured compliance with Medicare and HIPAA requirements. Customer Service & Technical Support Specialist iQor Philippines – AT&T Delivered customer and technical support for AT&T customers. Resolved billing, account, internet, mobile device, and technical concerns. Successfully completed Leadership Management Training for Team Leaders in 2018. Provider Services Representative Expert Global Solutions (now Alorica Philippines) – Anthem Dental Assisted dental providers with eligibility verification, claims, benefits, authorizations, and policy inquiries. Delivered exceptional customer service while meeting productivity and quality metrics. Accounting Assistant / Cash Disbursement & Audit Support CLP Metal Industries and Precision Tooling Assisted with bookkeeping, cash disbursement, auditing support, and financial documentation. Maintained accounting records and prepared reports for management. I am a dedicated and results-oriented professional committed to delivering exceptional service, maintaining the highest standards of accuracy, compliance, and patient care. With a strong background in healthcare operations, medical prior authorization, customer support, quality assurance, and administrative services, I am eager to contribute my knowledge, adaptability, and problem-solving skills to a forward-thinking organization. I value continuous learning