FALINA ADEBISI
Wilmington,Delaware
Summary
Experienced customer service professional skilled in data entry and claims resolution. Proficient in Epic, Google Suite, and Microsoft Applications. Adept at maintaining a thorough knowledge of claims processing systems and ensuring customer satisfaction.
Overview
19
19
years of professional experience
Work History
Provider Claims Service Representative
AmeriHealth Caritas
Philadelphia, PA
05.2023 - 07.2025
- Efficiently entered and managed data using electronic systems to enhance operational accuracy
- Resolved complex customer issues to ensure high levels of satisfaction and retention
- Adjudicated and reviewed claims with attention to detail, forwarding complex cases to appropriate departments
- Forward claims requiring external department intervention i.e., Appeals, Disputes, TPL Investigations, Optum Pause and Cotivity
- Verifying Authorizations submitted through JIVA
- Maintains thorough knowledge of claims processing systems, and its databases and subsystems, i.e. AVAYA PONE SYSTEM, COB LOOK-UP, CORS, COVITITY, ECIS, ELTSS, EXP, FACETS, IAD, JIVA, NPI CROSSWALK, NPPES, RAD MD, SORCE HOV
Customer Support Specialist
BNY Mellon
Wilmington, DE
08.2022 - 03.2023
- Company Overview: (TEMPORARY JOB PLACEMENT SERVICE)
- Provide the following services for customers who have Fidelity Debit / HSA Cards:
- Entered data accurately and efficiently into various electronic systems
- Activate / Cancel Cards, Balance Inquires, Investigate Declined Cards, and Large Purchase Advisories
- Lock / Unlock Cards, Order New or Renewal Cards, Order Replacement Cards
- Process Fraud / Dispute, Process Lost / Stolen Cards, Provide Shipping Information, Transaction Inquiries, Travel Advisories
- (TEMPORARY JOB PLACEMENT SERVICE)
Insurance Verification Specialist
Wound Healing Solutions
Barrington, NJ
12.2018 - 09.2022
- Verify insurances though practice management system and/or external websites (Novitasphere, NaviNet, NJ & NY Medicaid sites, Promise, Kareo and AlterPoint)
- Complete re-verifications monthly for recurring patients to ensure no gap in coverage.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Participated in training sessions on new software programs used for verification purposes.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
Coordinator for Neuropsychology
Children's Hospital of Philadelphia
Philadelphia, PA
07.2006 - 12.2018
- Verified and approved pre-authorizations via NaviNet and the PA Promise systems
- Developed tracking forms utilizing Microsoft Applications
- Reviewed and approved letters of medical
- Forwarded Psychiatric reports to families as requested by clinicians
- Ensured strict compliance with HIPAA regulations to patient privacy including processing HIPAA forms
Education
Diploma - undefined
Overbrook High School
undefined
Camden Canty College
Skills
- Epic
- Google Suite
- Microsoft Applications
- Decision-making
- Data entry accuracy
- Problem resolution
- Customer service software
- Claims Processing Systems
Highlighted Contributions
- Developed and implemented Intake Forms used throughout the organization and eventually used throughout the city of Philadelphia
- Proficiency = Epic, Google Suite, Microsoft Applications
- Assist and monitor budget preparation
- Assist with policy development and distribution
Timeline
Provider Claims Service Representative
AmeriHealth Caritas
05.2023 - 07.2025
Customer Support Specialist
BNY Mellon
08.2022 - 03.2023
Insurance Verification Specialist
Wound Healing Solutions
12.2018 - 09.2022
Coordinator for Neuropsychology
Children's Hospital of Philadelphia
07.2006 - 12.2018
Diploma - undefined
Overbrook High School
undefined
Camden Canty College
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