Foluke Miller

Houston, TX *****

ad3d9w@r.postjobfree.com

+1-346-***-****

Hard working and dedicated Bilingual Medical Billing and coding with previous experience in office procedures and working in a team environment.

• Medical Terminology Coding CPT ICD-10-CM

• E Clinical Works

• CPR/RDA Certified

• OSHA/HIPAA

• Computer Skills

• Data validation

• Data verification

• CRF Review and Tracking

• Microsoft Word and Excel

• Time Management

• Medicare/Medicaid

• Work on Phases I, II, III Clinical trials

• Edit checks programming

• Oracle Clinical 4.5

• SAS SQL

• Marketplace

• Generated and designed quarterly for clarification

• IDX

• Seibert

• E123, cyberX, NIA

• Inpatient and outpatient coding

• Insurance Verification

• EDC medidata Rave

• Commercial Insurance

• Epic: Asap, Inpatient; Radiant, CPOE, CLINDOC, ADT and Ambulatory, McKesson, Cadence, Optime

• Cerner: Ambulatory, Inpatient Power chart, CPOE, Anesthesia

• Sae reconciliation

• Experience providing elbow support for Physicians and Nurses

• Strong problem-solving abilities, as well as Independent and self-motivated

• Administrative assistant, patient care, customer service Authorized to work in the US for any employer

Work Experience

Care/Intake Coordinator

Cardinal Health - Houston, TX

October 2023 to Present

Delivering an exclusive model that fully integrates direct drug distribution to site-of-care with non- commercial pharmacy services, patient access support, and financial programs, Sonexus Health, a subsidiary of Client, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. Medical Terminology Coding CPT ICD-10-CM

Personalized service and creative solutions executed through a flexible technology platform means providers are more confident in prescribing drugs, patients can more quickly obtain and complete therapy, and manufacturers can directly access more actionable insight than ever before. Ability to handle high volume documents on queue and respond to fax using Salesforce and connect source.

Provider experience representative

Banner Health - Arizona

March 2023 to October 2023

• Assist provider in checking claims status and reprocess claims

• Assist pharmacy verify prior authorization

• Coordinate with patient, physician, insurance company and hospitals on the complete pre-certification process.

• Make and answer telephone calls from providers and insurance companies regarding the pre- certification process.

• Physician Revenue Cycle and Insurance Collections experience for government entities.

• Maintains assigned work queues within defined processing timeframe and meets or exceeds productivity standards. Runs all inpatient accounts through the Diagnosis Related Group (DRG) analyzer to determine that the codes are sequenced correctly and all code combinations have been considered to assure accurate DRG assignment.

• Traditional Medicaid and Managed Medicaid Plans – is required and Out-of-State Medicaid is a plus. This includes appealing insurance claim denials, underpayments, and understanding root cause analysis of insurance related activities.

• Process additional information request and coordinate with the insurance companies on requests for letters of medical necessity.

• Receive and process insurance information and forms from patients and insurance companies

• Review provider, chemotherapy schedules and worklist queues to ensure pre-certifications are obtained prior to the patient’s appointment.

• Perform other duties as assigned

• Ability to read and understand medical documentation to obtain information necessary for pre- certifications

HEDIS Specialist

AmeriHealth Caritas - Houston, TX

January 2023 to April 2023

• Meets individual performance standards. Performs other duties as may be assigned by management.

• Providing services and solutions to Associations, including customer service, administrative assistance, and strategic management solutions.

• Providing an open and effective line of communication between the patient and the healthcare provider, so the patient can get the most up to date information to make the best decision about their health care needs.

• Providing value-based insurance designs to promote and provide consumers with quality and cost- efficient health care services and choices.

• Providing back-office services that aid your company in functioning more efficiently and effectively. Services include premium collection, enrollment management, and fulfillment services. Customer Service Associate

Teleperformance (General Motors) - Houston, TX

February 2022 to December 2022

• Inbound calls

• Outbound calls to client Checking the validity and reliability of residents' information to support their identity.

• Assist customer to schedule vehicle service and oil change.

• Proper documentation of records for reference.

• Documents all encounters in clear and concise online logs. Transfers callers to other Call Center units as needed.

• Meets individual performance standards. Performs other duties as may be assigned by management.

• Picking up documents from various stations.

• Preparation of daily reports.

Provider Representative

Ambetter - Houston, TX

December 2021 to November 2022

• Inbound and outbound calls from members

• Assist customer to schedule appointments

• Assist member to search and change providers

• Documents all encounters in clear and concise online logs. Transfers callers to other Call Center units as needed.

• Assist provider in processing claims.

• Assist pharmacy verify prior authorization

• Check claims status for provider.

HEDIS Reviewer

Advent hospital - Texas City, TX

January 2022 to May 2022

• Service now to record ticket issues

• 96% accuracy on medical record review and abstraction

• Abstracted data from multiple records

• Worked with end users on issues and directed calls to appropriate channels

• Multitasked and troubleshoot problems

• Assisted in reviewing files and abstracting key data information (medical record of patients) Clinical Data Specialist

Tiger Med - Houston, TX

February 2021 to January 2022

• Prepared project budgets and timelines

• Worked with business development team to attract new clients

• Organized client data according to specific data requests

• Maintained data entry guidelines and procedures

• Outstanding ability to maintain and manage data

• Solid ability to adeptly juggle multiple tasks

• Strong understanding of regulatory procedures and guidelines

• Proficient in the use of Company Name applications

• Strong communications skills

• Performed data storage operations and archived data as requested

• Established cloud storage options for larger amounts of client data. Epic OpTime Go-Live Consultant

New York Presbyterian Cornell – New York, NY - New York, NY November 2021 to December 2021

• Provided end user one-on-one training as needed

• Assisted in setting up quick guides for easy access to tools and coverage for patients

• Assisted with how to fill one ticket issues and direct epic issues Provided support to providers and other end users during go-live support

• Worked closely with consultants during go-live to help escalate tickets, answer workflow questions on how the end users were trained.

• Responded to support requests from end users and patiently walked individuals through basic troubleshooting tasks.

Medical Biller and Coder(pt)

TEXAS FAMILY GERIATRIC CLINICS - Houston, TX

February 2021 to December 2021

Medical Billing and Coder

• Entering new patient information.

• Verification of patient insurance information and eligibility.

• Calculating and collecting payments for medical procedures and services.

• Updating patients data.

• Developing patients payment plan.

• Properly coding services and medical procedures, diagnosis, and treatments.

• Correcting rejected claims.

• Tracking payment.

• Inpatient and outpatient scheduling and verification

• Review and verifies documentation supporting diagnosis, procedures and treatments results. Billing Specialist/dispute specialist

Association of health care management - Houston, TX May 2021 to November 2021

• Also I am a dispute and fraud specialist at AHCM

• Providing services and solutions to Associations, including customer service, administrative assistance, and strategic management solutions.

• Providing an open and effective line of communication between the patient and the healthcare provider, so the patient can get the most up to date information to make the best decision about their health care needs.

• Providing value-based insurance designs to promote and provide consumers with quality and cost- efficient health care services and choices.

• Ability to use CMS 1500

• Providing back-office services that aid your company in functioning more efficiently and effectively. Services include premium collection, enrollment management, and fulfillment services. Medical Coding and Billing Specialist

West Houston Healthcare - Houston, TX

January 2020 to January 2021

• Maintaining knowledge of ICD-10, CPT and HCPCS codes.

• Communication with members and providers regarding their request.

• Inbound calls and outbound calls

• Maintaining detailed communication with physicians

• Approval of prior authorization, Billing and DME services requested from providers.

• Understand HIPAA

• Documentation of physicians orders

• Knowledge of working with different insurance companies like Medicare and Medicaid, ambetter, cigna. HEDIS Abstractor

The Cigna Group - Texas City, TX

March 2020 to May 2020

• Properly coding services and medical procedures, diagnosis, and treatments.

• Corrected rejected claims.

• Maintained HIPPA regulation for clients privacy and completed task in timely manner, ensured compliance with NCQA, federal, state, and other regulatory agency standards

• Reviewed and verified documentation supporting diagnosis, procedures, and treatments results.

• Worked on EMR team, completed medical record via remote access to provider EMR/HER systems

• Analyze, Abstract and compile medical information from patient records as a service to physicians, researchers and office associated with patient care

• Entered new patient information

• Extracted relevant information from medical record

• Updated patients’ data.

• Handled a high volume of telephonic interaction with office providers

• Collected and analyzed data

Clinical Data Manager

Ergomed Clinical Research Aug, 2016 - Houston County, TX August 2017 to March 2020

• Coordinated with Pharmacovigilance on serious adverse event reconciliation.

• Provided feedback on draft protocols, Statistical Analysis Plans, CSRs and other documents as required.

• Maintain data transfer specifications as agreed i.e External data specification

• Participated in assessment and decision making around new technologies.

• I review test transfers received from vendors to ensure that all data variables are consistent and aligns with the data transfer specification or data transfer agreement.

• Knowledge of Good Clinical Practices and Code of Federal Regulations/ICH Guidelines. Utilized Medidata Rave 4.5, Inform 6.1, iMednet, JReview, Microsoft Office (Word, Excel, Access, PowerPoint) and in-house query and tracking systems.

Epic Radiant Go-live Support

Houston Methodist Hospital September 2019 - Houston, TX January 2019 to December 2019

• Provided elbow to elbow support to clinicians as an intermediary

• Efficiently supported clinicians to navigate through their clinical workflow on hyperspace

• Assisted in scheduling, canceling and registration of patients as well as checking in and out

• Supported end users with placing orders and refills, medications, referrals and letters and how to effectively use the In-basket

• Provided elbow to elbow support to physicians on documenting, wrap up, level of service and charge capture

• Assisted physicians with personalization

• Assisted technologists in finding their images and lab encounters and also documenting on the flowsheet

HEDIS Reviewer

Pivot Consulting/Advent Health Hospital - Houston, TX January 2017 to May 2017

• Properly coding services and medical procedures, diagnosis, and treatments.

• Corrected rejected claims.

• Maintained HIPPA regulation for clients privacy and completed task in timely manner, ensured compliance with NCQA, federal, state, and other regulatory agency standards

• Reviewed and verified documentation supporting diagnosis, procedures, and treatments results.

• Worked on EMR team, completed medical record via remote access to provider EMR/HER systems

• Analyze, Abstract and compile medical information from patient records as a service to physicians, researchers and office associated with patient care

• Entered new patient information

• Extracted relevant information from medical record

• Updated patients’ data.

Education

College Degree in Medical Billing and Coding

ALTIERUS CAREER COLLEGE Houston - Houston, TX

July 2020 to February 2021

BSc in Demography and Social Statistics

Obafemi Awolowo university - Lagos, NG

2012

High School Diploma

Government College Lagos

2002

Associate's degree

Skills

• Medical Terminology Coding CPT ICD-10-CM

E Clinical Works

CPR/RDA Certified

OSHA/HIPAA

Microsoft Word and Excel

Time Management

Medicare/Medicaid

Marketplace

Insurance Verification

Commercial Insurance (3 years)

• Microsoft Office

• ICD-9

• Medical Billing

• EMR Systems

• Statistics

• Medical Coding

• CPT coding

• ICD-10

• Medical collection

• Medical Records

• IT Support

• Medical Office Experience

• Regression Analysis

• Acute care

• Filing

• HCPCS

• DRG

• Managed care

• Computer networking

• Clerical Experience

• Analytics

• Documentation review

• Medical scheduling

• Typing

• Quality assurance

• Public health

• Clinical laboratory experience

• Laboratory experience

• Cold calling

• Sales

• Benefits administration

• Negotiation

• ICD coding

• Accounts Receivable

• Problem-solving

• Flexibility

• Team Work

• Reliability

• Machine Learning

• Auditing

• Accounting (5 years)

• Supervising experience

• Compounding medications

• Account analysis

• SAP

• Physiology knowledge

• Anatomy knowledge

• SQL

• Hospital experience

• Business analysis

• QuickBooks

• Medical receptionist

• Payroll

• Leadership

• Management

• Contracts

• Pricing

• Data collection

• EDI

• Logistics

• CRM software

• Microsoft Project

• Microsoft Excel

• Epic (3 years)

• English

• iOS

• Mac OS

• Customer support

• Microsoft Access

• Intake

• Pivot tables

• NetSuite

• Accounts payable

• ERP systems

• SAP ERP

• Communication skills

• PCI

• Employment & labor law

• Google Docs

• Human resources

• Information security

• Telemarketing

• Telemarketing

• Behavioral health

• Windows

• Phone etiquette

• Account reconciliation

• Salesforce

• Workday

• Avaya

• Fraud

• Conflict management

• GCP (1 year)

• Idx (2 years)

• CPT coding (5 years)

• ICD-10 (5 years)

• Microsoft SQL Server

• Help Desk

• Oracle

• Databases

• Active Directory

• Data analysis skills

• HEDIS

• Clerical experience

• EMR systems

• Medical records

• Microsoft Office

• Project management

• Outpatient

• Visio

• Microsoft Excel

• Microsoft Word

• Microsoft Powerpoint

• Management

• Medicare

• Managed care

• English

• Computer skills

• Communication skills

• ICD-9

• Microsoft Outlook

• NCQA standards

• Ob/Gyn

• Revenue cycle management

• Clinic

• Windows

• School experience

• SharePoint

• Home health

Certifications and Licenses

Medical Billing Certification

Present

Medical Coding Certification

Present

Certified Professional Coder

In progress

CPR Certification

Certified Coding Specialist

Good Clinical practice

Present

Clinical data management software

Present

RHIT

RHIA

AHIMA

Certified Medical Assistant

LPN

RRT

RN License

Groups

AAPC

July 2020 to Present

Contact this candidate