Revenue Cycle Customer Service

Lydia Orogun

Frisco, TX ***** • 682-***-**** • **************@*****.***

Professional Summary

A Revenue cycle specialist with superior skills working in both team base and independent capacities, and in-depth understanding of follow-up and billing procedures bringing forward years of experience, expertise on insurance claim management, reducing denials and improving revenue outcomes. Skills

Revenue collection report preparation Coordinating Documents Accurate Notations Strong attention to details and accuracy Maintaining detailed records Claims review

Verifying Insurance Ability to independently identify areas of concern regarding various areas of revenue cycle

Insurance follow up Healthcare billing proficiency Customer service Proficient in Microsoft word, Excel and outlook

Work History

Revenue Cycle Specialist, 04/2022 to 06/2024

Cornerstone Healthcare Group Holding – Remote

Following up on unresolved claims and working denials to resolution. Utilizing payer portals and phone calls to get claim status patient accounts. Performing account follow-up activities on high-dollar and aging accounts. Identifying technical and Clinical denials and working them to resolution Appropriately. Reduced outstanding account balances by implementing effective collection strategies. Resolved complex payment issues such as denials, underpayments or incorrect coding. Works all assigned insurance payers to ensure proper reimbursement on patient accounts to expedite resolution.

Outbound calls to insurance companies to verify coverage, eligibility as well as claim status. Monitor claim status, research rejections, denials, and document related account activities. Processes medical, administrative, technical appeals, request refunds when applicable, and rejections of insurance claims

Track routine follow up with payers to ensure reimbursement of billed claims Determine most efficient process to resolve refund requests or credit balance. Initiate patient outreach on delinquents payments for patient responsibilities on claims Recognizes potential issues within claims and collections process and recommends and implements solutions for improvement

Research missing payments and secure documents needed for posting. Follow up with payers to ensure timely resolution of all outstanding claims, via phone calls, payer portals review, fax or websites.

Responsible for managing patient account in processing accounts and working with designated payers to ensure proper reimbursement

Contacts patient when there is need to update information or COB Monitor and Send Claim Files electronically or Paper Claims to Commercial, Medicare and Medicaid

Track common claims errors, identify and reports inaccurate reimbursement and contractual trends Identified billing errors, short payments, overpayments and unpaid claims and resolved them accordingly

Posts adjustments and collections of Medicare, Medicaid, medicaid managed care and commercial insurance payers

Contacted responsible payer for status of claim

Filing appeals for denied claims or claims that requires reconsideration Revenue Cycle Specialist, 05/2019 to 04/2022

Fairview Health Services – Remote

Resolves claim edits within practice management billing system to ensure successful claim submission

Daily communication with insurance companies and other commercial insurers to address coordination of benefits and claims resolution.

Reviewed EOBs for correct payment, deductible, adjustments and denials. Sets follow-up activities based on status of a claim. Generated receivables reports and offered improvement recommendations. Reached out to insurance companies to verify coverage. Work and manage claims from all aging buckets including posting and appeals. Ability to multitasks and prioritize tasks to accomplish and maintain goals Effectively navigate and utilize various healthcare provider software systems Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.

Resolve healthcare claims through verbal or online inquiries to health insurance payers. Verify accuracy of insurance and patient information Verify insurance data entry along with scheduling, and confirming appointments Post adjustments and collections of medicare, medicaid, medicaid managed care and commercial insurance payers

Read and interpret insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and take appropriate steps to resolve issues. Revenue Cycle Specialist, 06/2016 to 04/2019

Genesis Medical Center – Dallas, TX

Identified and resolved payment issues between patients and providers. Resolved system billing and claim WQ edits by working closely with clinical departments, coding staff and registration to assure errors are competed correctly and in a timely manner. Utilize account information to assist in write-offs for inclusive CPTS by payor. Communication with insurance payers to ensure proper coverage for patients or to ensure timely and accurate reimbursement for services rendered.

Work with payor throughout the resolution process

Investigate and coordinate insurance benefits for insurance claims across multiple service lines Review and interpret payment information from the EOB (explanation of benefits) to accurately apply payment and adjustment when necessary.

Research denied claims to determine reason for denial by contacting the payor and reviewing the EOBS or R&S.

Customer Service Representative, 02/2015 to 05/2016 Wipro Technologies – Plano, TX

Effectively handled inbound and outbound calls on 401k participants Accurately and successfully process service transactions and reached resolution on member issues in a timely and effective manner

Ability to effectively establish rapport, communicate information and diplomatically respond to inquiries from callers

Ability to multi-tasks including navigating between computer applications while speaking with participants/payers on the phone

Tactically handles confrontational or stressful interactions with customers Handled customer inquiries and suggestions courteously and professionally. Actively listened to customers, handled concerns quickly and escalated major issues to supervisor. Answered constant flow of customer calls with minimal wait times. Education

Bachelor of Arts: Linguistics, 08/2015

University of Ilorin - Kwara State, Nigeria

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