Ruth Ogboh
forney
Summary
Detail-oriented and highly skilled Revenue Cycle Specialist with over [4] years of experience in managing the financial operations within healthcare organizations. Proficient in all aspects of the revenue cycle, including medical billing, coding (ICD-10, CPT, HCPCS), claims management, accounts receivable, and patient collections. Expertise in leveraging healthcare software systems, such as Epic, Cerner, Prism, aria, ikm and Meditech, to optimize billing processes and ensure accurate and timely reimbursement. Adept at analyzing revenue cycle metrics, resolving claim denials, and ensuring compliance with regulatory standards, including HIPAA and CMS guidelines, healthcare and medical claim overpayment and refunding.. Competent and detail-oriented Accounting Assistant well-versed in accounts payable and receivable management, financial forecasting, budgets, and payroll. Talented in identifying and correcting errors for impeccable accuracy. Committed to achieving team objectives and driving company development. Proactive communicator with solid foundation of trustworthy and dependable performance.
Overview
6
6
years of professional experience
Work History
Hospital Billing/UBO4Insurance Accounting Representative
Allyhealth
Plano
11.2023 - 07.2025
- Company Overview: Contract
- Daily communication with insurance payers, including commercial and government entities, to address coordination of benefits, resolve discrepancies, and ensure reimbursement on claims.
- Analyzing accounts to determine if the balance is ready to bill the next payer, making sure deadlines are met.
- Examination and management of claims requiring medical record requests from payers.
- Tracking common claim errors, identifying inaccurate reimbursement, and contractual trends, and reporting findings.
- Conducting follow-up actions, documenting follow-up activities and conversations with payers, and setting follow-up activities based on claim status.
- Contacting patients to address missing or incorrect claim information, such as member IDs
- Utilizing payer portals and interacting with third-party payers and patients to resolve account balances
- Identifying and resolving billing errors, underpayments, or overpayments
- Notating accurate claim status information provided by payers and identifying potential resolutions for proper reimbursement
- Reviewing, analyzing, and resolving complex claims issues and payer behavior using billing systems, payor portals, and EOB reviews
- Reviewing daily clearinghouse rejections, resolving issues, and resubmitting accounts as needed
- Posting adjustments and collecting payments from Medicare, Medicaid, and commercial insurance payers
- Reporting appeals to supervisors/managers for review and escalation when supported by strong documentation
- Adhering to legal and ethical guidelines of HIPAA for safeguarding patient and company confidential information
- Reviewing accounts and taking steps to resolve payment by contacting payers, processing rebilling requests, and escalating issues when necessary
- Collecting patient copays, coinsurance, and deductible amounts due after insurance processing
- Contract
Accounts Receivable Specialist
West janisch health care center
08.2021 - 06.2023
- Managed accounts receivable functions for a busy surgical center, ensuring timely and accurate billing and collections processes
- Generated and submitted insurance claims for surgical procedures, adhering to payer requirements and guidelines to maximize reimbursement
- Conducted thorough review and verification of patient insurance coverage and eligibility, minimizing claim denials and rejections
- Resolved billing discrepancies and insurance claim rejections promptly, communicating with payers and patients to gather necessary information and documentation
- Review payer bulletins and websites for changes in rules and regulations
- Followed up on outstanding accounts receivable balances, including aging reports and unpaid claims, to facilitate prompt payment and revenue optimization
- Implemented effective collection strategies, including phone calls, letters, and payment plans, to recover outstanding balances and minimize bad debt
- Collaborated with the billing team to identify trends in claim denials and payment issues, recommending process improvements and corrective actions as needed
- Reconciled accounts receivable transactions and maintained accurate records in the billing system, ensuring compliance with regulatory requirements and internal policies
- Provided exceptional customer service to patients and insurance companies, addressing inquiries and concerns related to billing and insurance matters
- Contributed to team meetings and training sessions, sharing insights and best practices to enhance departmental efficiency and effectiveness
AR Collection Representative
Molina healthcare
11.2019 - 07.2021
- Responsible for managing patient account staff in processing accounts and working with designated payers to ensure proper reimbursement
- Ownership of assigned Payer AR and all activities required to identify underpayments and prepare accounts for escalation to the payers in order to drive account resolution
- Resolve claims in a timely manner by completing appeals as needed or driving materials and accounts through the Plan Manager to the Payer
- Identify and resolve escalated billing issues for efficient problem resolution
- Act as the billing vendor liaison to resolve billing issues
- Take prompt and appropriate actions to rectify any issues
- Analyze Explanation of Benefits (EOBs) and remittance advice to identify payment discrepancies
- Collaborate with insurance companies, payers/stakeholders to address payment and reimbursement
- Use patient-centric strategies to manage and resolve complex billing issues with compassion and patience
- Assess trends in escalated issues and make recommendations for service enhancements
- Interpret account record, including claim history, transaction record, and account notes
Education
Associate - arts
Mountain View Collage
Dallas, TXSkills
- Time management
- Prioritization
- Teamwork
- Collaboration
- Communication
- Attention to detail
- ICD -10 Management Skills
- Claim processing
- Customer Service Orientation
- Medical Billing
- Proficiency in Healthcare Software
- Health Care billing
- Problem Solving in Billing and claims
- Refund Analyst
- Cash Posting Specialist
- Hospital billing UBO4
Timeline
Hospital Billing/UBO4Insurance Accounting Representative
Allyhealth
11.2023 - 07.2025
Accounts Receivable Specialist
West janisch health care center
08.2021 - 06.2023
AR Collection Representative
Molina healthcare
11.2019 - 07.2021
Associate - arts
Mountain View Collage
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