Medical Claims Revenue Cycle

Olaide Aina

**** * ******* ***, ******* Illinois 60619

Email: ad5xhn@r.postjobfree.com

PROFESSIONAL SUMMARY

Dedicated revenue cycle Specialist with a comprehensive background in medical claims submission, adjustments and coding. Proven expertise in strategic decision-making to optimize revenue steams and minimize denials. Adept at health care data analysis, entry and migration ensuring accurate and efficient processes. Known for exceptional communication skills and the ability to collaborate cross-functionally. Proficient in data abstraction techniques, driving organization efficiency and compliance.

EDUCATION

Bachelors of Arts: Mass Communication

Babcock University, Ogun State, Nigeria

SKILLS

Healthcare Data Analysis and entry Data migration and abstraction Insurance Follow up process Medical claims submissions, adjustments, and coding Strategic decision making Excellent Communication

TECHNICAL COMPETENCY

• Office Skills: MS Office, Word, Excel, PowerPoint, and Project

• Practice Management Software Applications: EPIC, gen, CUBS, Cerner Power chart, Star, Change healthcare, Advanced MD, Medicare/Medicaid servicing applications.

• Knowledge of data processing, hardware platforms, and enterprise software applications.

• Excellent Customer Service skills

PROFESSIONAL EXPERINCE

Insurance Follow up Specialist (01/10/2021-04/26/2024)

Maxi care llc. Inverness IL. 60067

Assisted in filing insurance claims, determining write-offs, and resolving coding issues.

Placed outgoing calls and receive incoming calls to facilitate collection and resolution of insurance accounts

Prioritized daily workload to efficiently work claim in consideration of dollar amount and timely filling deadlines

Provided insight to clinical staff regarding why claims are denied and how denials can be avoided in the future to maximize collections.

Completed claim edits and resubmissions within timely filing guidelines.

Collaborated with insurance payers to determine why claims have been denied and what information is needed to resubmit claims successfully

Prepared claims for compliant and timely submission to insurance carriers

Worked with team member to meet goals, target and deadlines

Assisted patient by handling billing Questions

Medical Billing Representative (01/2017- 05/2020)

Spirant Management, Chicago IL

Implemented and monitored billing system business rules, appliance tasks, interfaces, correcting errors and making necessary modifications.

Coordinated Revenue cycle for all Spirant Clients In- depth knowledge of claims follow-up, entailing both claim payment posting and claim denial appeals.

Vast knowledge of Medicare/ Medicaid, HMO, and PPO plans along with knowledge of plan specific denials; which has aided in my expertise for appealing denials for pay outs.

Claims submission, correspondence between patients and various healthcare providers; maintain and organize patient records and charts.

Daily billing tasks such as payment posting, insurance recoupment and patient refund processing, patient statement mailing.

Provided detailed documentation on the collection system to explain the action taken or promise made

Established and maintained effective communication with employees, other health care providers, insurers, and patients to secure accurate and pertinent information to maximize reimbursement (Communicated with internal and external customers by telephone and mails to verify charge accuracy and correct account errors)

Prioritized daily workload to efficiently work claim in consideration of dollar amount and timely filling deadlines

Claims Processor- Team Lead, (07/2015- 12/2016)

Radiant Skin Dermatology and Laser, Anaheim CA.

• Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments.

• Research current trends in healthcare coding and compliance and update stakeholders on regulations and events that impact physician coding and billing.

• Provided coding and billing assistance.

• Orchestrated day-to-day operations of the billing department, including medical coding, payment posting, accounts receivables and collections.

• Compiled coding data and analysis and provide comprehensive statistical reports.

• Reviewed insurance payments and denials to establish coding trends and provide feedback to coding specialists and management.

Medical Billing Representative, (01/2014 - 05/2015)

SG Med Resources, Stafford TX.

• Researched claim denials and completes adjustments accurately and timely.

• Verified that payments received are correct.

• Followed up on reimbursement and appeals in an efficient and timely manner.

• Efficiently utilized all functions of the client's software applications, including maintaining accurate and detailed charts and notes.

• Clearly, accurately, and concisely document notes in medical software system per company guidelines.

• Observed legal and ethical guidelines of HIPAA for safeguarding patient and company confidential and proprietary information.

• Consistently provided exceptional customer service.

• Promoted company culture by adhering to all policies and procedures.

REFRENCE

This will be provided upon request.

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