chris alvarez
TRANSCRIPT
Passport Road. Al Falah Street, Abu Dhabi, United Arab [email protected]
CHRISTOPHER R. ALVAREZ
OBJECTIVE: Experienced REGISTERED NURSE [data entry operator medical claims processor and medical claims officer] seeking a challenging role in the field for professional challenge and growth to support and enhance co-operative objectives of the company.
SKILLS & ABILITIES: Strong analytical ability with initiative. Good interpersonal and communication skills. Strong problem solving and decision making capabilities. Very good written and verbal communication skills. A capable team leader with focus on achieving strategic
organizational objectives through a team centric approach. Knowledge of medical terminologies such as current procedural
terminology, CPT codes and International Classification of diseases or ICD codes. [ICD CODES 9 & 10]
Well trained in DRG CODING for inpatient. Proficient in Microsoft Applications (Ms. Word, Excel & PowerPoint
Microsoft Outlook). Strong medical knowledge. Well trained in CPT CODES A hands-on problem solver with a high rate of achievement and an
appetite for new challenges evolving innovative solutions. Ability to adapt well and perform in new competitive environment. Can work well in both team environment and individual
assignments. A motivated and diligent team player utilizing excellent
communication, interpersonal skills with strong analytical mind-set to learn quickly, to analyze the situation, identify requirements and provide solutions.
WORKING EXPERIENCE: FMC NETWORK UAE [DATA ENTRY/ MEDICAL CLAIMS PROCESSOR/ MEDICAL CLAIMS OFFICER]
ABU DHABI,UNITED ARAB EMIRATES
JANUARY 18, 2008 UP TO DATE:
Evaluate medical necessity and consistency of diagnosis, procedures and drug codes and descriptions stated on the claims according to accepted medical coding rules and guidelines while processing claims accordingly to daily target, quality and other key performance indicators.
Granting approvals for outpatient procedures, diagnostic tests, pharmacies and inpatient cases as per policy terms and conditions.
Responsible for reviewing, auditing medical claims, evaluate pending claims, reconciliation and handling pre-authorization request with assuring excellent customer service.
Ensure accurate application of contractual prices and discounts, schedule of benefits, correct allocation of benefits, collection of deductibles, co-payments, observance of policy limits, and adherence to claims submission protocols.
Reviewed and made sure that there is no omitted information. Kept thorough records of claims and followed up on dropped cases. Entered claims into computer utilizing knowledge of CPT ICD CODES
and medical terminology. Coordinate with providers to make procedures more cost effective. Assist in managing pre-authorization business to optimize cost
efficiencies and subject to medical and policy eligibility. Assist in implementation of medical claims processes, reconciliation
protocols and to communicate and clarify to clients, providers and intermediaries.
Minimize fraud by conduction of provider visits, second opinions and profiles.
Deliver high quality customer service and respect medical and work ethics at all times.
Communicate work related issues clearly and effectively with the team members and superiors.
Evaluates and enters the details of medical claims in the system as per policy terms and conditions.
STAFF NURSE: AMERICAN HOSPITAL [ACUTE CARE UNIT/WARD/OPD] with MOH License: DOHA,QATAR
FEBRUARY 25,2006 – OCTOBER 4, 2007
Provide individualized nursing care to all patients. General nursing care such as recording patient medical information,
assisting physicians during examination. Administering prescribed medications, typically intravenously,
ordering and evaluating diagnostic tests, monitoring specialized equipment and interpreting electronic displays such as cardiac monitors, respirators, ventilators, manometers and oxygen pumps as well as responding to life threatening situations based upon standing protocols.
Patient education plans typically include post treatment home care and detailed instructions regarding medications and rehabilitation.
Performs or oversees the collection of holistic assessment and the development and implementation of plan of care.
Oversees the management of patient care.
Page 2
Trouble shoots complex problems in patient care, documents findings and progress in patient record.
Provides briefings to new care providers and reviews pertinent information for provision of care.
Ensure patient family preparation for care across continuum. Reviews all patient information including lab and other test results and
progress notes in patient health record daily. Reviews consultation notes and or speaks directly with consultants to
discuss care. Assess patient’s response to treatment and care through other care
provider information or by examining patient directly. Consults with physicians and other healthcare providers to
communicate patient progress. Disseminates and implements latest evidence based practices to nursing
colleagues. Ensures that patient goals are set with patient and patient’s family
involvement. Provides or oversees the education of the patient and family to
understand illness and self-care concepts.
STAFF NURSE; QUEZON MEDICAL CENTRE [SURGERY AND ER DEPARTMENT]
LUCENA CITY, PHILIPPINES
SEPTEMBER 24, 2004- JANUARY 24, 2006
Provides specialized nursing care to patients who undergone a surgery.
Preparing patients prior to the surgery. Work in critical care emergency facilities to assist doctors and work
with emergency medical technicians in helping people in pain and possibly life threatening trauma.
Provide care, monitor health conditions, plan long term care needs, administer medicine, use medical equipment, perform minor medical operations and advise patients and their families on illness, care and continued care after hospital stay.
Quickly assess the needs of each patient, prioritize care based on its critical nature.
Treat the problem, discharge the patient after the emergency is over or make arrangements for a longer hospital stay.
Identify the medical problem Document medical history. Check for any allergies and current medications. Assess a patient’s health as well as detect changes in symptoms health or
pain and will need to know when action is necessary. Comply with protocols, procedures and safety policies of a health care
facility.
EDUCATION: Bachelor of Science in Nursing [2000]CEFI- De La Salle Supervised School
Page 3
Lucena City, Philippines
St. Francis High School [1995]SECONDARY EDUCATION: Sariaya Quezon, Philippines
TRAININGS/ACHIEVEMENTS: Immediate Life support (ILS Provider Course No. 245/989/ILS-231) Hamad International Training Centre Doha, Qatar June 30, 2006
6th Annual Symposium on Emergency Medicine Makati Medical Centre Department of Emergency Medicine Makati City, Philippines September 29, 2005
Intravenous Therapy [with license] Basic Life support [Philippine Red Cross] Basic First Aid Training [Philippine Red Cross] Employee of the year 2014 [FMC NETWORK UAE] Florence Nightingale Award [CEFI DE LA SALLE SUPERVISED SCHOOL
OF NURSING]
PERSONAL DETAILS: Registered Nurse [Professional License No.337857] Can speak Tagalog and English Passport Number EB9524806 Filipino National Visa status Employment/Residence Permit Single Roman Catholic
CHARACTER REFERRENCE AVAILABLE UPON REQUEST
Page 4