KOFFI ADJOGBLE
Brooklyn Park,MN
Summary
EPS Tactical Training Group (PER MAR SECURITY) Private Detectives and Protective Agents (PER MAR SECURITY)
Overview
14
14
years of professional experience
1
1
Certification
Work History
Volunteer
Christ Covenant Chapel Media Department
Brooklyn Center, MN
- Lead and manage 20 Team members
- Responsible for technical functions of the sound board
- Work closely with Team members to stay updated with the church happenings
- Oversee and strategize with the Team to develop an effective outcome
- Delegate all duties of the Media Team to the Team members
- Responsible for staying updated of Media trends and determine how they can be implemented
- Manage the Church Website, Facebook and Instagram accounts.
COB Claims Specialist
Prime Therapeutics
Eagan, MN
03.2020 - Current
- Responding to inquiries from internal and external partners for the research of and resolution of claim issues
- Monitor and troubleshoot all details of claims processing activities in a testing environment including root cause analysis, error correction, reconciliation processes and claims recovery projects
- Serve as a subject matter expert resource for coworkers and other departments
- Responsibilities
- Monitor and respond appropriately to incoming inquiries related to specific process or support systems (e.g
- Claim adjudication system) escalate issues when appropriate
- Assist with RxClaim Release user acceptance testing and reporting
- Manage and Supervise Team members for assigned Projects
- Leadership experience
- In charge of a Team coaching, performance review, manage develop, supervise
- Medicare part D
- Processing of Other Health Insurance Retroactive Report
- Manage and supervise the daily Coordination of Benefit configuration in a health plan payer environment
- Processing of Payment and Refund Request
- Processing of Patient Assistance Program Prior Authorization
- Process Monthly Financial Information Reporting
- Review and ensure quality assurance processes are followed and all the necessary approvals are obtained before configuration are moved into production environment
- Manage and Review the Monthly Other Health Insurance claims process including error correction, claims recovery and communicate to the appropriate clients.
Senior Recovery Resolution Specialist
Optum
Eden Prairie, MN
09.2018 - 02.2020
- Answered in-coming calls from the Provider Inquiry Line and the Fraud Hotline from members questioning claim status, review status, appeal status and reporting of fraud
- Served as a subject matter expert for claims related to provider data
- Logged of all in-coming calls in a Call Tracking Documentation System
- Maintained accuracy standards of 97% or greater
- Maintained adherence standards of 95% or greater
- Ensured adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Worked independently and as part of a team
- Identified issues requiring additional investigation or evaluation
- Acted as a resource for others
- Analyzed provider data claims issues, and resolve encounter data discrepancies
- Managed special projects supporting team objectives
Insurance Account Specialist
Professional Service Bureau
Anoka, MN
06.2017 - 06.2018
- Followed up on outstanding medical claims for all payers
- Reviewed patient bills for accuracy and completeness and obtained any missing information
- Submission of claims in a timely manner
- Identified issues with accounts from Explanation of Benefits and Denials
- Checked each insurance payment is for accuracy and compliance with contract discount
- Called insurance companies regarding any discrepancy in payments if necessary
- Identified and billed secondary insurances
- Answered all insurance telephone inquiries pertaining to assigned accounts
- Conducted status checks with insurance companies and determined if appeal process is available
Clinical Review Technician
Prime Therapeutics
Bloomington, MN
10.2012 - 05.2016
- Reviewed and documented claims processing system in internal request tracking database
- Accurately handled physician calls related to Clinical Review process
- Consistently exceeded team goal by 50%
- Led and worked closely with the team to identify and prioritize initiatives on specific projects
- Assisted in commutation between clients and company regarding policies and procedures surrounding coverage of non-formulary medications and utilization management processes
Pharmacy Technician
Unity Hospital
Fridley, MN
05.2011 - 08.2012
- Prepared and processed medical claim forms and records
- Supplied and monitored robotic machines that dispense medicine into containers
- Maintained records of controlled substances per the Minnesota Board of Pharmacy’s rules
- Operated cash register to accept payment from customer
- Worked with insurance companies on approving payment on medications
Material Handler
Unity Hospital
Fridley, MN
10.2010 - 05.2011
- Accurately and efficiently delivered medical supplies to specified destinations
- Effectively managed incoming communication and resolved all issues within established service-level agreements
- Precisely filled carts and dispatched orders in assigned patients’ rooms
- Printed appropriate labels and maintained inventory
Customer Service Representative
800
Minneapolis, MN
11.2008 - 07.2009
- Conducted and documented an average of 200 phone surveys weekly, exceeding target by 25%
- Worked closely with team to identify, prioritize initiatives
- Managed multiple projects/initiatives effectively including the ability to identify, define, measure, analyze, innovate, improve and control problems that are without clear pattern
- Managed risks and issues effectively by resolving or escalating to the appropriate individuals
- Recognized for providing outstanding service to customers and exceeding department goals
- Dance Your Heart Out for One Heartland - Fund Raising Event
- Soccer tournament, Fund Raising Event.
Education
Bachelor of Arts -
Bethel University
Pharmacy Technician Diploma - undefined
Master of Arts - Cybersecurity
Saint Mary's University of Minnesota
Winona, MNSkills
- HIGHLIGHTS OF SKILLS & QUALIFICATIONS
- Experience with claim processing and healthcare billing
- Extensive leadership experience resulting in stronger team and individual performance
- Ability to establish working relationships with external stakeholders
- Strong written, oral, and interpersonal communication skills
- Highly effective critical thinker and team player
- Expert knowledge of Microsoft Office applications, and computer systems
- Ability to multi-task & understand multiple networks, product lines, and levels of benefits within the products
- Ability to meet critical deadlines
- Ability to communicate effectively with all levels of management
- Knowledge of governmental, and third-party payer reimbursement
- Organized, flexible, quick learner
- Positive communicator, creative, and motivated
- Knowledge of
- Medicare PART D, MN health care program, Commercial and Medicaid
- Experience in work assignment with Team members until completion
- Strong operational Management in health plan provider system
- Knowledge of CMS Enterprise Portal
Certification
Pharmacy Technician Certification
OSHA Training Certificate
First Aid Certified
HIPAA Certified
Additional Information
- HONORS AND AWARDS , Everest Institute, 2009 Ambassador-Everest Institute, 2009 Go for the Green Award-Hilton Hotel, 2004
Timeline
COB Claims Specialist
Prime Therapeutics
03.2020 - Current
Senior Recovery Resolution Specialist
Optum
09.2018 - 02.2020
Insurance Account Specialist
Professional Service Bureau
06.2017 - 06.2018
Clinical Review Technician
Prime Therapeutics
10.2012 - 05.2016
Pharmacy Technician
Unity Hospital
05.2011 - 08.2012
Material Handler
Unity Hospital
10.2010 - 05.2011
Customer Service Representative
800
11.2008 - 07.2009
Volunteer
Christ Covenant Chapel Media Department
Bachelor of Arts -
Bethel University
Pharmacy Technician Diploma - undefined
Master of Arts - Cybersecurity
Saint Mary's University of Minnesota
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