Abiodun Adenle
Lynn,MA
Summary
Healthcare Operations Specialist with over eight years of experience supporting both providers and payers through accurate verification, documentation review, and complex authorization workflows. Experienced in handling OB/maternity, urgent, and emergent cases while working with payer portals such as NEHEN, Availity, and Humana-Tricare Military. Known for managing high-volume workloads while maintaining accurate, compliant records and collaborating with cross-functional teams to keep processes moving efficiently. Reliable, detail-oriented, and easy to work with, I bring the same level of care and accuracy to credentialing and enrollment activities as I do to authorization work.
Overview
14
14
years of professional experience
Work History
Obstetrics, Urgent & Emergent Prior Authorization
Mass General Brigham
Boston, MA
12.2015 - Current
- Verified provider, patient, and payer information in Epic to ensure accurate, timely authorization processing and maintain clean data workflows supporting credentialing and enrollment.
- Utilized NEHEN, Availity, Tricare, Humana Military, and commercial payer portals for eligibility checks, authorization submissions, enrollment inquiries, and issue resolution.
- Reviewed clinical and insurance documentation for accuracy, completeness, and compliance with HIPAA, NCQA, CMS, and AAAHC standards.
- Analyzed authorization requests to ensure alignment with payer policies and organizational procedures.
- Maintained detailed, audit‑ready records and ensured timely updates to support onboarding, compliance, and payer requirements.
- Collaborated with providers, case management, revenue cycle teams, and payers to resolve discrepancies and obtain missing information.
- Worked closely with healthcare providers to gather required documentation and support timely approval of services.
- Processed MA Medicaid Notices of Birth (NOBs), ensuring timely benefit activation and accurate newborn enrollment.
- Reduced authorization errors and denials by researching policy guidelines, verifying benefits, and correcting documentation issues.
- Researched and resolved denied claims, communicated with payers, and ensured accurate data entry for all authorization and claim activities.
- Streamlined workflows by identifying process gaps, implementing best practices, and contributing to faster turnaround times.
- Mentored new staff and supported training initiatives to strengthen team knowledge and operational performance.
- Provided clear, empathetic support to patients and providers navigating authorization and insurance requirements.
- Demonstrated strong problem‑solving skills by addressing complex coordination issues and adapting to shifting departmental priorities.
- Ensured strict confidentiality of patient information and maintained compliance with all regulatory requirements.
Appeals & Grievance Coordinator (Temp)
Tufts Health Plan
Watertown, MA
07.2015 - 12.2015
- Reviewed provider and member documentation for accuracy and compliance with NCQA, CMS, and state regulations.
- Prepared complete, compliant case files for internal and external review, similar to credentialing committee file preparation.
- Communicated with providers and internal teams to obtain missing information and clarify requirements.
Management Intern (Graduate Fellowship)
Veterans Affairs – Edith Nourse Rogers Memorial VA Hospital
Bedford, MA
06.2014 - 08.2014
- Supported compliance and internal affairs initiatives, reviewing documentation and assisting with regulatory training.
- Developed an Equal Employment training manual and facilitated sessions on compliance and complaint processes.
- Assisted with data analysis, reporting, and policy adherence activities.
Nursing Assistant Coordinator
Horizon Home Care & Hospice
Milwaukee, WI
08.2012 - 05.2014
- Maintained accurate patient records and verified demographic and insurance information to support clean billing and authorization workflows.
- Ensured documentation met regulatory standards and supported coordinated patient care.
- Trained and mentored staff on documentation accuracy and workflow processes.
- Assisted patients with daily living activities, ensuring comfort and dignity.
- Monitored vital signs and reported changes to nursing staff promptly.
- Collaborated with healthcare team to develop patient care plans.
Education
M.S. - Health Informatics Administration
University of Maryland Global Campus
Adelphi, MARYLAND01-2023
B.S. - Healthcare Administration
University of Wisconsin–Milwaukee
Milwaukee, WI01-2014
Skills
- Credentialing & Enrollment
Provider data verification File preparation Compliance documentation Record maintenance Onboarding support
Payer & SystemsEpic NEHEN Availity Tricare Humana Military Commercial payer portals
Healthcare OperationsEligibility & insurance verification Prior authorizations Retro-auths Claim reconsiderations Case tracking
ComplianceHIPAA NCQA CMS AAAHC Regulatory alignment
Professional StrengthsTime management Problem‑solving Communication Organization Accuracy Multitasking Team collaboration
Affiliations
- Future Healthcare Executives
- UW–Milwaukee VA Outreach Program
- Blood Center of Wisconsin
- Leadership Healthcare Forum
Timeline
Obstetrics, Urgent & Emergent Prior Authorization
Mass General Brigham
12.2015 - Current
Appeals & Grievance Coordinator (Temp)
Tufts Health Plan
07.2015 - 12.2015
Management Intern (Graduate Fellowship)
Veterans Affairs – Edith Nourse Rogers Memorial VA Hospital
06.2014 - 08.2014
Nursing Assistant Coordinator
Horizon Home Care & Hospice
08.2012 - 05.2014
M.S. - Health Informatics Administration
University of Maryland Global Campus
B.S. - Healthcare Administration
University of Wisconsin–Milwaukee