Abayomi Anisere
Grand Prairie,TX
Summary
Patient-focused professional equipped with administrative and customer service expertise. Helps keep healthcare services proceeding smoothly by coordinating communications, referrals, and policy enforcement. Talented in finding balanced solutions and resolving conflicts.
Overview
7
7
years of professional experience
Work History
Claims Resolution Analyst
Magellan Healthcare
Dallas, TX
05.2022 - 05.2024
- Explained policy coverage, liability and denials to policyholders, lawyers and other involved parties.
- Processed adjustments and posted refunds.
- Investigated issues to determine appropriate coverage and liability for medical claims.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Documented all information gathered and uploaded data to company database for efficient processing using MedHost Software.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to all issues.
- Maintained excellent attendance record, consistently arriving to work on time.
- Resolved conflicts and negotiated mutually beneficial agreements between parties.
- Followed up with customers on unresolved issues.
- Maintained confidentiality of patient finances, records and health statuses.
- Reviewed outgoing bills for eligibility and accurateness.
- Adhered to established standards to safeguard all patients' health information.
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Transferred balances to correct payers.
- Communicated with insurance providers to resolve any denied claims and resubmit.
- Efficiently collected payments and communicated with clients.
- Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments.
- Participated in workshops and other training opportunities to remain current on billing procedures, regulations and industry updates.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Patients Services Specialist
Cencora
Dallas, TX
11.2020 - 05.2022
- Ensured compliance with all applicable laws, regulations, and standards related to healthcare services.
- Verified patient's insurance eligibility through web portals or phone calls to insurance companies.
- Handled a variety of activities including inbound phone inquiries,determination for support programs,pharmacy triage and coordination as well as order processing for whole sales order.
- Conducted thorough research and resolved claims denials or underpayments,ensuring accurate processing of claims.
- Greeted and welcomed patients in a friendly manner.
- Performed data entry into electronic health record systems as needed.
- Adhered to established policies and procedures while maintaining compliance with applicable laws.
- Troubleshot and resolved department issues to maintain patient satisfaction and keep optimal patient flows.
- Verified demographics and insurance information to register patients in computer system.
Heaslthcare QA Coordinator
Optimumhealthmedicalgroup
Dallas, Texas
03.2018 - 10.2020
- Analyzed data and performance metrics to identify treads,area for improvement and opportunities to enhance patient care.
- Developed and implemented quality improvement initiatives and best practices to address identified issues and optimize healthcare process.
- Collaborate with healthcare providers,administrators and other stakeholders to communicate findings and drive continuous improvement efforts.
- conduct audits and reviews of healthcare services to ensure compliance with regulatory standards and internal quality assurance protocols.
- Reviewed documents for accuracy prior to submitting them for processing.
- Maintained patient files, including medical history and financial records.
- Prepared reports summarizing patient interactions and departmental performance metrics.
- Verified patient's insurance eligibility through web portals or phone calls to insurance companies.
- Coordinated insurance authorizations, collected co-payments and resolved discrepancies.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
QA Inspector
Texas Fueling Services
Midland, TX
12.2016 - 02.2018
- Conducted process audits to ensure compliance with established standards.
- Tested products for performance and reliability.
- Developed methods for inspecting newly developed products.
- Participated in root cause analysis investigations when necessary.
- Analyzed data to identify trends or patterns of defective parts.
- Recorded test results in logbooks and databases.
- Used root cause analysis tools to determine failures and provide appropriate counter-measures to prevent repeat failures.
- Examined products and materials for defects or deviations to remove or discard non-conforming items.
- Learned new testing methods through continued education and research.
- Recommended essential corrective actions based on test results.
Education
Associate of Applied Science -
Osun State Polytechnic
Osun State07-2002
GED -
School of Science Pade
Oyo State10-1996
Skills
- Insurance Verification
- Multitasking and Organization
- Quality Assurance
- Regulatory Compliance
- Flexible Schedule
- Time management
- Teamwork
- Adaptability
- Problem solving
- Empathy
- Active listening
- Computer proficiency,including microsoft office suite
- Data entry
- Understanding healthcare terminology and processies
Languages
English
Professional
Abayomi Abolade Anisere
- Posses All line claims Adjuster certification.
- Caring.
- and Helping people
Timeline
Claims Resolution Analyst
Magellan Healthcare
05.2022 - 05.2024
Patients Services Specialist
Cencora
11.2020 - 05.2022
Heaslthcare QA Coordinator
Optimumhealthmedicalgroup
03.2018 - 10.2020
QA Inspector
Texas Fueling Services
12.2016 - 02.2018
Associate of Applied Science -
Osun State Polytechnic
GED -
School of Science Pade
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