OLUWAFUNMIKE SARAH ADESANYA
Richmond,US
Summary
Dynamic and adaptable Medical Customer Service Specialist with a proven track record at R1 RCM, enhancing patient satisfaction through expert appointment scheduling and meticulous attention to detail. Excelled in patient confidentiality compliance and healthcare insurance knowledge, boosting process efficiency by 30%. Renowned for exceptional teamwork and critical thinking abilities, consistently delivering superior customer service.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Substitute Teacher
Fort Bend Independent School District
Richmond TX
02.2026 - 05.2026
- Developed effective communication strategies with parents to discuss student achievements and challenges.
- Evaluated student performance regularly, adjusting instructional methods based on individual progress assessments.
- Improved student behavior management by implementing consistent classroom routines and positive reinforcement strategies.
- Maintained open lines of communication with families regarding student progress, concerns, or additional supports needed at home or in school settings.
- Implemented evidence-based interventions that targeted specific skill deficits while monitoring progress towards IEP goals.
- Assisted students in achieving academic growth by providing targeted instruction based on their unique learning needs.
Process Assistant
Amazon Logistic Centre
Brookshire, TX
04.2024 - 02.2026
- Streamlined workflow processes to enhance operational efficiency across multiple departments.
- Trained and mentored new process assistants on standard operating procedures and best practices.
- Monitored inventory levels, ensuring timely replenishment and minimizing stock discrepancies.
- Developed and maintained documentation for standard operating procedures to ensure consistency in operations.
- Implemented quality control measures, improving accuracy of order fulfillment by reducing errors.
- Ensured compliance with safety regulations by conducting thorough audits and addressing potential hazards promptly.
- Facilitated knowledge sharing among team members, fostering a culture of collaboration and innovation.
MEDICAL CUSTOMER SERVICE REPRESENTATIVE
R1 RCM (Robert Half Staffing)
10.2023 - 04.2024
- Re-scheduling patient appointments as required via telephone calls and written notification to patients
- Screening and routing patient calls to other departments efficiently, insuring accurate registration, appointment scheduling and follow-up appointment scheduling in database
- Providing answers to their questions, provide pre-authorization for medical treatment, and provide them with information about co-payments and related inquiries
- Working on computers and answering phones to intake information in a busy environment
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures.
- Identified opportunities to improve processes related to customer service operations.
- Developed relationships with customers through active listening and follow-up calls.
- Maintained accurate records of all customer interactions in the company database.
- Utilized effective communication techniques to resolve patient inquiries and complaints promptly and professionally.
- Worked closely with supervisors to develop strategies that would enhance the overall quality of customer service operations.
- Prepared detailed reports regarding customer trends, complaints, resolutions.
- Processed incoming payments for services rendered in accordance with established procedures.
- Provided excellent customer service to patients, staff and physicians in a medical office setting.
- Resolved customer complaints promptly and professionally.
- Ensured compliance with HIPAA regulations when discussing patient information with internal and external customers.
- Monitored call queues on a daily basis to ensure prompt response times for incoming calls.
- Assessed customer needs accurately and provided appropriate solutions or referrals within established guidelines.
- Implemented new technology initiatives designed to streamline existing processes related to customer service delivery.
MED D PRIOR AUTH IB PHONE TECH REP II, OPERATIONS/MEDICARE PART D
E-Team Inc Staffing: (Staffing Agency)
New Jersey
07.2023 - 10.2023
- Running Test claims in RX Claims system to get rejection codes for medication
- Taking inbound calls from MDO, Pharmacy retail, Pharmacist, and calls from members
- Create Prior Authorizations, for Non-Formulary, Quantity Limited, Smart Edit, Step Therapy, Tiering Exceptions, for medications
- Hospice request, Redetermination, also create request for Medicare Part B and send to Organization Determination for further review
- Utilize People safe to run hard test claims for rejections when no claims are on file in RX claims
- Knowledge of Medicare benefits, enrollments and LIS assistance programs
- Participates in cross-training to perform all roles within the department
- Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners
- Paying close attention to details, also must be organized, and, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines
- GPI searches for medications to do manual overrides for certain Health plans.
REFERRAL SPECIALIST I EXPERT SLP/RBM/SURG
AIM Specialty/ (Anthem Blue Cross & Blue Shield)
Houston, US
06.2021 - 06.2023
- Initiates and manages clinical referrals for pre-authorization
- Acts as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources
- Reviews referrals for completeness and follows up for additional information if necessary
- Assigns escalated referrals to staff as appropriate
- Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures
- Responds to inbound calls initiating exam requests following established processes, meets quality and production standards
- Contacts physician offices as needed to obtain demographic information or related data
- Enters referrals, documents communications and actions in system
- Create Preauthorization for surgical procedures
- Conduct P2P with Ordering MD's, NP, Physician Assistants to get PreAuthorizations Approved
- Meets established productivity, schedule adherence and quality standards.
CUSTOMER SERVICE LEAD REPRESENTATIVE
Mind Lance Staffing: (Staffing Agency)
New Jersey
07.2020 - 05.2021
- Customer Service Lead Representative is responsible for intake, processing of oral and possibly written grievances, conducting root cause analysis as needed, creating an action plan, coordinating and communicating resolutions, as well as documenting systems in detail with case notes related to Customer grievances
- Skills Excellent oral, written communication skills & critical thinking ability required
- Ability to track and manage case load effectively in call tracking system
- Able to work independently and under pressure related to tight timeframes
- Problem solving skills required
- Working knowledge of MS Word, Excel and the ability to pick-up and work in multiple computer systems is required
- Customer-centric mindset
- Prior Medicare Advantage background preferred
- Call center, Grievances or Appeals department experience preferred.
CUSTOMER CARE REPRESENTATIVE EXPERT
Mind Lance Staffing: (Staffing Agency)
New Jersey
02.2020 - 05.2020
- Proactively guiding and resolving members and providers questions and concerns using computer-based resource
- Explaining benefits to providers and members explain EOB, EOC Claims, Appeals, and Grievance etc
- Initiating grievance and appeals on behalf of members
- Answering 80-100 calls on a daily from members and providers, other health care insurance
- Helping members find doctors via telephone calls, online chats and or emails etc
- Creating correspondence and sending out letters to members and providers offices
- Right Fax to provider's office to verify member's coverage of insurance etc
- Act as trusted advisor and educator for our members and providers for health care related inquires
- Have passion for serving others with the ability to be empathetic and understanding of member's and providers concerns
- Strong work ethic and sense of responsibility for my teammates and members
- Experience with Medicaid, HMO, PPO, POS, EPO, CDHP, health insurance plans
- Have clinical and non-clinical expertise related to grievance and appeals for quality of service, quality of care issues that may include executive and regulatory grievances
- Health Plan expertise for different plan states and guidelines
- Reissue Checks from health plan when members or Providers have not received their reimbursement or Payments
- Plan to Plan for local Blue Cross Blue Shield plans in other states when regarding claims
- Deal with claims daily and sending claims back for any adjustments that was not process correctly by health plan.
PROVIDER OPERATIONS COORDINATOR
Anchorage Staffing: (Staffing Agency)
Chicago, US
10.2019 - 01.2020
- Support Provider Relations Field Reps with inquires of claims and payment issues for providers
- Root cause analysis of operational and health service issues
- Track new contracts through Sidewinder
- Audits configuration loads on new provider contracts
- Process and review in and out going paperwork, such as directory updates, provider Credentialing applications, contract maintenance forms and Cactus, QNXT etc
- Answering incoming phone calls from providers and assist with their concerns with resolution of issues
- Special Projects are performed as needed and assigned or directed to be completed.
CLINICAL COORDINATOR
UnitedHealth Group
Sugarland, US
10.2017 - 08.2019
- Resolve customer service inquiries which could include: Enter notifications, Providers status of an existing notification and determining if notification is required
- Complete notification wizard along with ICD-10 and CPT coding
- Provide excellent customer service to both providers and enrollees
- Assist with faxes and emails
- Job will encompass all areas of intake for Long Term Care as well as ongoing collaboration with health Plan personnel
- Build authorizations in UHC systems
- (HCBS)
- Make outbound calls to providers for acquiring all required clinical documentation as specified
- Collaborate with Service Coordinator staff / Works Independently
- Assign specific authorizations to Prior Authorization staff
- Process referrals for TMHP services
- Correct authorizations based on a daily error report
- Provide clear and accurate documentation
- Receive incoming calls from a queue of members or provider
- Knowledge of Prior Authorization Case turnaround times (TAT)
- Resource for others/ On the job training for new hires
- Extensive work experience within (HCBS) and own functions
- Meets established productivity, schedule adherence and quality standards.
INTAKE COORDINATOR
Randstad USA
Glen Mills, US
11.2016 - 09.2017
- Respond to incoming provider and enrollee calls
- Resolve customer service inquiries which could include: Enter notifications, Providers status of an existing notification and determining if notification is required
- Complete notification wizard along with ICD-9 and CPT coding
- Provide excellent customer service to both providers and enrollees
- Assist with faxes and emails
- Job will encompass all areas of intake for Long Term Care as well as ongoing collaboration with health Plan personnel
- Build authorizations in UHC systems
- Make outbound calls to providers for acquiring all required clinical documentation as specified
- Collaborate with Service Coordinator staff
- Assign specific authorizations to Prior Authorization staff
- Process referrals for TMHP services
- Correct authorizations based on a daily error report
- Provide clear and accurate documentation
- Accurately fax authorizations to providers
- Receive incoming calls from a queue of members or provider.
PATIENT SERVICE COORDINATOR/RECEPTIONIST
MD Anderson Cancer Center
Houston, US
04.2015 - 10.2016
- Assisted patients/personnel in clinic and via phone
- Provided timely, courteous and knowledgeable responses to information requests
- Interacted professionally with all levels of staff and maintain the highest level of confidentiality
- Communicated pertinent information regarding upcoming appointments with patients
- Interpreted and coordinates physician orders
- Maintained Physician's clinic schedules
- Ensured Prepayment financial counseling to patients/ families
- Obtained and records accurate demographic and insurance information on patients
- Ensured that the correct insurance plan codes are utilized for the billing process
- Answered telephone calls and routing calls to appropriate staff, care givers.
Education
Bachelor of Education - Educational Leadership And Management
University of Ibadan Nigeria
07-2013
Associate Degree - Industrial Relations and Trade Unionism
University of Ibadan Nigeria
Nigeria09-2009
Skills
- Patient Registration
- Customer Relationship Building
- Problem Solving Aptitude
- Conflict Resolution Techniques
- Active Listening Abilities
- Organizational Skills
- Attention to Detail
- Critical Thinking Abilities
- Teamwork and Collaboration
- Patient Confidentiality Compliance
- Computer Literacy
- Precertification
- Product Knowledge
- Multitasking Capabilities
- Healthcare Insurance Knowledge
- Telephone Etiquette Mastery
- Medical Records Management
- Appointment Scheduling Expertise
- Medical Terminology Proficiency
- Professionalism and Courtesy
- Strong Interpersonal Skills
- Adaptability and Flexibility
Certification
- Texas life insurance license, 2023-10-01
- Certificate Medical Billing & Coding, 2016-11/2017-09
Timeline
Substitute Teacher
Fort Bend Independent School District
02.2026 - 05.2026
Process Assistant
Amazon Logistic Centre
04.2024 - 02.2026
MEDICAL CUSTOMER SERVICE REPRESENTATIVE
R1 RCM (Robert Half Staffing)
10.2023 - 04.2024
MED D PRIOR AUTH IB PHONE TECH REP II, OPERATIONS/MEDICARE PART D
E-Team Inc Staffing: (Staffing Agency)
07.2023 - 10.2023
REFERRAL SPECIALIST I EXPERT SLP/RBM/SURG
AIM Specialty/ (Anthem Blue Cross & Blue Shield)
06.2021 - 06.2023
CUSTOMER SERVICE LEAD REPRESENTATIVE
Mind Lance Staffing: (Staffing Agency)
07.2020 - 05.2021
CUSTOMER CARE REPRESENTATIVE EXPERT
Mind Lance Staffing: (Staffing Agency)
02.2020 - 05.2020
PROVIDER OPERATIONS COORDINATOR
Anchorage Staffing: (Staffing Agency)
10.2019 - 01.2020
CLINICAL COORDINATOR
UnitedHealth Group
10.2017 - 08.2019
INTAKE COORDINATOR
Randstad USA
11.2016 - 09.2017
PATIENT SERVICE COORDINATOR/RECEPTIONIST
MD Anderson Cancer Center
04.2015 - 10.2016
Bachelor of Education - Educational Leadership And Management
University of Ibadan Nigeria
Associate Degree - Industrial Relations and Trade Unionism
University of Ibadan Nigeria