AR & Aging Management
30-60-90+ day buckets, with high-dollar prioritization.
Gail Tolentino
Senior Claims Analyst & AR Follow-Up Specialist (7+ Years Experience)
Results-driven Claims Analyst with 7 years of experience navigating complex healthcare revenue cycles. Proven track record of reducing aging A/R, resolving commercial and government claim denials, and expediting insurance cash flow.
Core competencies
Where I add value in the revenue cycle, from the first follow-up call to the final appeal.
Denial & Appeal Resolution
CARC/RARC codes:
- CO-18
- CO-45
- PR-27
Payer & Portal Navigation
Availity, Medicare FISS/DDE, Medicaid, and phone escalations.
Compliance & Coding Rules
ICD-10, CPT, HCPCS, Modifiers 25/59, HIPAA and CMS.
Systems I work in: Meditech Live/Expanse, EPIC, Finthrive, Cirius Clearing House, Webex, Google Workspace
Work experience & metrics
Seven years in US healthcare billing, with the numbers to show for it.
- $32,000recovered in the featured case study
- 200+denied claims overturned
- 45–60AR days now, down from up to a year
- 42–80claims worked per day, by complexity
Claims Analyst / AR Follow-Up
Med-Metrix Manila, Ortigas
Feb 2023 – Current
A/R reduction
Reduced AR days from up to a year to 45–60 by resolving the issues behind payer payment delays, working 42–80 claims a day depending on complexity.
Denial management
Overturned 200+ denied claims with appeals and state complaints backed by accurate billing information and supporting documentation.
Payer reconciliation
Process adjustments, refunds, under- and overpayments and credit balances according to the facility’s contract.
Cross-functional collaboration
Work with coding and front-desk teams to correct billing errors at the source, and with the onshore client on high-dollar projects ($50,000–$2,000,000).
Healthcare Executive
Omega Healthcare, Ortigas
Sept 2021 – Feb 2023
Validated patients’ outstanding balances, handled payment processing, and talked with patients to understand the cause behind each balance.
Customer Service Representative
Agents.ph, San Juan City
Sept 2018 – Sept 2021
Supported patients and providers on authorizations, eligibility and claims: authorization status and modifications, coverage updates, claim status and denial reasons.
Featured case study
Denial Resolution Matrix: CO-197 authorization denials.
| Challenge | Action | Result |
|---|---|---|
| A high rate of missing-authorization denials on outpatient procedures. | Standardized pre-auth confirmation procedures before billing. |
40% reduction in authorization denials $32,000 recovered |
Case details are anonymized. No patient information is shown.
Open to remote AR follow-up roles.
Night shift, any time zone. Send me a note and I’ll reply promptly.
Ghailtolentino25@gmail.com · Trece Martires, Cavite, Philippines