Wasilat Odumosu
Jamaica,NY
Summary
Detail-oriented healthcare professional with 5 years of experience in Customer Service, Revenue Cycle Management, and Credentialing. Expertise in providing accurate support for billing, insurance inquiries, and claims processing while ensuring HIPAA compliance. Proven remote collaborator in fast-paced environments, committed to enhancing service delivery and maintaining compliance.
Overview
6
6
years of professional experience
Work History
Revenue Cycle Specialist
CVS Minute Clinic
Remote, NY
05.2024 - 02.2026
- Managed patient account inquiries to ensure timely resolution and satisfaction.
- Reviewed billing statements to ensure accuracy and adherence to policies.
- Coordinated with insurance providers to confirm coverage and benefits for efficient claims processing.
- Analyzed claims data to identify trends and potential issues.
- Verified patient insurance coverage, benefits and eligibility to ensure fast and effective billing process.
- Accurately submitted EOBs from Other Insurance carriers to designated departments to ensure claims paid correctly.
- Collaborated with medical office staff to resolve billing discrepancies and patient account issues.
- Prepared and submitted clean and accurate electronic or paper claims to insurance payers.
- Resolved claims denials, rejections, and underpayments through detailed research and analysis.
- Prepared and submitted appeals with supporting documentation.
- Ensured all processes comply with HIPAA, CMS guidelines and contract regulations.
- Processed payments and reconciled accounts to maintain financial integrity.
- Reached out to responsible companies and individuals to collect on outstanding debts.
BSW Health
Credentialing Specialist
Remote, NY
09.2022 - 01.2024
- Collecting, reviewing and processing initial applications, reappointments and or recredentialing packets which include payer enrolment forms for completeness and accuracy
- Served as primary contact for providers and operations teams, facilitating communication and collaboration.
- Collected, verified and evaluated state licenses, certifications, background checks, compliance documentation while following company policy.
- Maintained strict confidentiality of sensitive provider information in accordance with HIPAA and internal policy.
- Tracked credential expiration dates and proactively notified providers 75days in advance reducing lapses by 40%
- Updated provider information in credentialing software system to ensure accuracy.
- Submitted documentation to insurance payers for enrollment, monitored progress, resolved issues, and confirmed network status.
- Oversaw full-cycle initial and re-credentialing for 120+ registered nurses and allied healthcare providers across multiple facilities.
Customer Service Representative
CVS-Aetna
Remote, NY
08.2020 - 06.2022
- Provide accurate information on insurance coverage, services provided and facility/provider network status
- Answer inbound calls in a timely manner
- First point of contact between providers and Our company To provide accurate information
- Verify and update Member/Patient information with providers
- Provide accurate patient benefits with providers, view accumulations and explain how balance bills are processed
- Document and notate all interactions, inquiries, notes and resolutions accurately in the systems for record keeping, follow up and compliance
- Triage calls to determine urgency, Route clinical inquiries to right department
- Reviewed pre-authorizations and procedures for approval under members' plans and advised on related requirements.
- Review processed claims and give accurate information.. Either regarding reconsideration or appeals related
- De-escalate and empathize with providers with recurring claims issue
- Maintain strict HIPAA COMPLIANCE by protecting patients' health information and ensuring confidentiality
- Stay up to date with changes in insurance policies, plans, healthcare services while maintaining company policy
- Meet performance metrics which include AHT, Call Resolution rate, SCAD, QA target and Key performance indicators [KPIs] and trainings
Education
Bachelor of Science - Insurance
Lagos State University
Skills
- Revenue cycle management
- Claims processing
- Insurance verification
- EOB submission
- Benefits and Eligibility
- ICD-10, CPT, HCPCS
- Database Entry
- Salesforce, Rocket Rumba, Iris
- MS Office {Word, Excel, Outlook}
- Typing Speed 45 WPM
- Call handling
- Customer relationship management
- Problem solving
- Fluent in English
Timeline
Revenue Cycle Specialist
CVS Minute Clinic
05.2024 - 02.2026
BSW Health
Credentialing Specialist
09.2022 - 01.2024
Customer Service Representative
CVS-Aetna
08.2020 - 06.2022
Bachelor of Science - Insurance
Lagos State University