YETUNDE KOIKI
HUDSON,FL
Summary
Experienced Healthcare Claims Professional with a decade of expertise in healthcare claims processing, specializing in ICD-10 and CPT coding. Proven track record in building trust and developing strong customer relationships through effective communication with healthcare providers, members, and clients. Committed to ensuring high satisfaction for both clients and the company by utilizing exceptional communication skills and providing excellent service.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Clinical Support Analyst
Persivia
01.2023 - Current
- Provide clinical support to members, managing coverage gaps with guidelines and policies
- Assist in the development and enhancement of clinical workflows and processes
- Analyze and interpret clinical data to identify trends and opportunities for improvement
- Collaborate with cross-functional teams to implement and evaluate evidence-based practices
- Facilitate communication between healthcare providers and patients, ensuring adherence to clinical guidelines
- Monitor and report on key performance indicators related to clinical support activities
Support Analyst Contract Position
Persivia
05.2023 - 12.2023
- Assisted in the development and implementation of clinical support processes
- Collaborated with cross-functional teams to improve clinical workflows
- Provided training and support to healthcare providers on clinical guidelines and policies
- Analyzed clinical data to identify trends and opportunities for improvement
Sales Development Representative
Magnet Global
09.2022 - 02.2023
- Managed key stakeholder relations process, ensuring accuracy and adherence to documentation by reviewing RFPs and maintaining communication with stakeholders
- Collaborated with internal stakeholders, including the New Business Manager and Pursuit Teams, to set prospective client quotes, while maintaining accurate records in Salesforce
Claims Representative I
Cognizant
07.2021 - 06.2022
- Facilitated RFP workflows by effectively communicating with leaders and internal customers, ensuring appropriate processes and supporting decision-making across the business
- Conducted data entry and analysis, effectively designing and monitoring of specified requirements to ensure proper submission of internal applications and evaluation of special claims using appropriate guidelines
Medicare Service Operations - Claims Benefits
Specialty Medicare and Medicaid
09.2020 - 07.2021
- Analyzed and processed claims for diverse clients, including HSPs, independent physicians, and hospitals, ensuring accuracy and compliance with established guidelines
- Collaborated with cross-functional teams to resolve complex claims issues and provide guidance on claims processing procedures
- Utilized data analysis tools to identify trends and opportunities for process improvement, resulting in increased efficiency and reduced processing times
Licensed Customer Service Associate (04-40 License)
Liberty National Insurance
01.2017 - 10.2019
- Reviewed and analyzed claims, providing clear and empathetic assistance for personal insurance policies and claims, ensuring compliance with established frameworks
- Assisted in the development and implementation of claims processes, improving policyholder satisfaction and reducing processing times
- Maintained strong relationships with internal stakeholders, ensuring a positive impact on premiums and claims, and complied with agreed upon service plans
Medicare Inbound Contact Rep
Medicare Inbound Contact RFP
11.2018 - 09.2019
- Efficiently navigated multiple systems to verify member eligibility and benefits, and communicated complex information regarding claims, pharmacy, and appeals to members and providers
- Handled members on Medicare Advantage plans, including Part C and D, as well as additional benefits, ensuring compliance with established guidelines and providing accurate information to members and providers
Telecommute Member and Provider Representative
Humana
04.2018 - 03.2019
- Efficiently assigned multiple systems to verify member eligibility and benefits, and communicated complex information regarding claims, pharmacy, and appeals to members and providers
- Handled members on Medicare Advantage plans, including Part C and D, as well as additional benefits, ensuring compliance with established guidelines and providing accurate information to members and providers
Formal Claims Examiner
Humana
12.2014 - 12.2016
- Reviewed and analyzed claims for healthcare providers regarding benefits, claims, and eligibility, ensuring compliance with established guidelines
- Collaborated with cross-functional teams to resolve complex claims issues and provide guidance on claims processing procedures
- Conducted data analysis to identify trends and opportunities for process improvement, resulting in increased efficiency and reduced processing times
Education
Associate of Arts Degree - undefined
St. Petersburg College
Skills
- Microsoft Word (Experienced), Excel (Experienced), PowerPoint (Experienced), Outlook (Experienced), Adobe (Experienced), Photoshop (Experienced), HEDIS (Experienced), ICD-10 Coding (Advanced), CPT Codes (Experienced), ICD-9 (Experienced), Medical Terminology (Experienced), Interpersonal Mediation (Experienced), Claims Processing (Experienced), Telephone (Experienced), Communication (Experienced), Risk Review (Experienced)
Certification
6204-40 License
Awards
Perfect attendance certificate -1st quarter, Determined and creative Employee of the quarter -3rd quarter2015, Highest R.T.R. Award -2016,2nd Quarter2017, Handled highest produced deals -2017, Best improved team rate -2018
Timeline
Support Analyst Contract Position
Persivia
05.2023 - 12.2023
Clinical Support Analyst
Persivia
01.2023 - Current
Sales Development Representative
Magnet Global
09.2022 - 02.2023
Claims Representative I
Cognizant
07.2021 - 06.2022
Medicare Service Operations - Claims Benefits
Specialty Medicare and Medicaid
09.2020 - 07.2021
Medicare Inbound Contact Rep
Medicare Inbound Contact RFP
11.2018 - 09.2019
Telecommute Member and Provider Representative
Humana
04.2018 - 03.2019
Licensed Customer Service Associate (04-40 License)
Liberty National Insurance
01.2017 - 10.2019
Formal Claims Examiner
Humana
12.2014 - 12.2016
Associate of Arts Degree - undefined
St. Petersburg College
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