Atinuke Iyun

Lead Logistics Support
Accomplishments:

•  Improved Interdepartmental communication which generates 40% more effectiveness
   Outsourcing technical support for 25% more efficient outcomes
  Responsibilities:
  • Human resource management
  • Performed needs analysis to determine performance gaps and developed appropriate tactics to resolve issues
  • Scheduling and coordinating meetings within the department
  • High level management and Ad hoc reporting
  • Implementing problem solving skills to maintain focus
  • Consistently met organizational and departmental objectives, within budget, and time constraints.

• Achieved error-free claims adjudication for at least 2 quarters in 4 years
• Created a word document that reduced work time by 40%
• Working knowledge of Federal HMO health policy, OPM/FEHB, MD & VA HMO health policies, Medicare, and MD COBRA Laws & Regulations
• Ensured adherence to HIPAA policy
• Analized members claims for benefits under the ACA health policy
• Analized and adjudicated Professional and specialty claims like Durable Medical Equipment, Physical Therapy, Physiotherapy, Abortion, Vision & case rate claims
• Ensured provider contracts and members’ eligibility status are current
• Analized members’ health policy
• Adjudicated medical claims via TAPESTRY, DIAMOND, KMATE, HEALTHCONNECT, MACESS, and DSPBN systems
• Coordinated benefits according to Medicare and other coordination of benefits (COB) guidelines and policies
• Responded to claims issues reviewed by the Medical Director
• Maintained great working relationship with membership administration, referral, data management departments to ensure accuracy
• Responded to audit inquiries
• Analized members eligibility and providers contracts to determine contract status.