Chiamaka John
Frisco
Summary
Results-driven Revenue Cycle Specialist with over 6 years of experience in healthcare financial management and client servicing. Expertise in optimizing revenue cycle processes, identifying root causes of issues, and managing billing and collection operations. Proven success in resolving denied claims, drafting compelling appeal letters, and submitting necessary medical records to enhance revenue outcomes. Recognized for a collaborative approach, strong analytical skills, and adaptability to evolving industry demands while consistently delivering exceptional results.
Overview
7
7
years of professional experience
Work History
Revenue Cycle Specialist
Jorie AI
05.2022 - 12.2025
- Optimized revenue streams by promptly identifying and resolving billing discrepancies.
- Analyzed denial types and crafted detailed appeals for no authorization, medical necessity, and non-covered services to facilitate resolution.
- Followed up on billed claims, identified denial reasons, and worked payers specific workflows to resolve outstanding AR.
- Submitted appeals and reconsiderations with supporting documentation such as medical records, itemized bills, and proof of timely filing when required.
- Communicated with insurance providers via phone calls and payer portals to resolve claims, verify coverage and eligibility, and verify claim status.
- Managed COB denials by coordinating with patients when necessary.
- Identified and billed secondary insurances.
- Communicated identified payer trends such as denials for specific procedures, diagnosis codes, or other identified issues.
- Examines documents for missing information and corrects information when needed.
- Observed legal and ethical guidelines of HIPPA for safeguarding confidential and proprietary information of patients and companies.
- Identified billing errors, underpayments, overpayments, and unpaid claims and resolved them accordingly.
Revenue Cycle Specialist
Ova on Healthcare
Remote
04.2020 - 05.2022
- Researched the denied claim to determine the reason for denial by contacting the payor and reviewing the EOB.
- Processed Hospital Revenue cycles and insurance collections in commercial payers (BCBS, AETNA, UHC, etc.) and government entities (Traditional Medicaid and managed Medicaid plans).
- Resolved system billing and claim WQ edits by working closely with the clinical department, coding staff, and registration to ensure errors were corrected correctly and on time.
- Ensure accurate billing and timely submission of electronic and paper claims.
- Post adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance.
- Perform follow-up actions and document follow-up activities, conversations with payors, and guarantors' information.
- Performed appeal insurance claim denials, underpayments, and understanding root cause analysis of insurance-related activities.
- Track common claims errors, identify, and report inaccurate reimbursement and contractual trends.
- Resolve accounts as quickly and accurately as possible, obtaining maximum reimbursement, and perform investigative activities in fast-paced environment.
- Increased revenue by identifying and resolving billing errors in a timely manner.
Revenue Cycle Specialist
Total Point Healthcare Inc
Dallas, TX
02.2019 - 03.2020
- Analyzed claims and ensured all pertinent information is organized and prepared to assist with efficient processing.
- Collected payment for outstanding claims and ensured payments received and reconciled correctly.
- Reviewed EOBs for correct payment, deductible, adjustment, and denials.
- Reconcile commercial and government accounts, ensure CPT and diagnostic codes are accurate.
- Reached out to insurance companies to verify coverage.
- Successfully negotiate and manage payer contracts, ensuring favorable terms and compliance with payer guidelines, resulting in higher reimbursements.
- Prepared and submitted insurance claims for a diverse range of patients, including private, Medicare, and Medicaid.
- Monitored and tracked insurance claims to ensure timely payments and followed up on denials and underpayments.
- Participated in regular training and education to maintain compliance and improve revenue cycle efficiency.
- Implemented successful collection strategies, including the distribution of payment reminders and diligent follow-up calls.
- Spearheaded insurance verification efforts, ensuring timely and accurate assessments of patient eligibility and benefits.
Education
Bachelor of Science - Computer And Information Sciences
Ambrose Ali University
Ekpoma, Edo State, Nigeria05-2016
Skills
- Claims review
- Time Management
- HIPAA compliance
- Insurance eligibility and benefits verification
- Experience in using EHR systems including Epic, Meditech
- Hospital billing/UB-04
- Professional billing/CMS-1500
- Analytical problem solving
- Claims status monitoring
- Claims processing proficiency
- Professionalism and ethics
- Medical billing/follow-up in Government and Commercial claims
- Denial management and appeals
- Managing records
- Claims review, submission, and tracking
- Patient and payer communication
- Processing reconsideration requests
Timeline
Revenue Cycle Specialist
Jorie AI
05.2022 - 12.2025
Revenue Cycle Specialist
Ova on Healthcare
04.2020 - 05.2022
Revenue Cycle Specialist
Total Point Healthcare Inc
02.2019 - 03.2020
Bachelor of Science - Computer And Information Sciences
Ambrose Ali University