Damola A Giwa

A enthusiastic Revenue cycle specialist with superior skills working in both team base and independent capacities, bringing forward years of experience, expertise and in-depth understanding of billing procedures, insurance claim management, reducing denials and improving revenue outcomes.

Revenue Cycle Specialist at Cornerstone Healthcare Group Holding (2022-04 – 2023-09)

Resolved complex payment issues and managed insurance claims in electronic billing systems.

• Resolved complex payment issues such as denials, underpayments or incorrect coding
• Correct medicaid claims in electronic billing system for missing or invalid Insurance, or patient information according to procedures
• Outbound calls to insurance companies to verify coverage, eligibility as well as claim status
• Monitor claim status, research rejections, denials, and document related account activities
• Identified and resolved payments issues between patients and providers
• Determine most efficient process to resolve refund requests or credit balance
• Identified and billed secondary insurances engaged in reading RA/EOBs and post payment accurately with great attention to detail
• Recognizes potential issues within claims and collections process and recommends and implements solutions for improvement
• Research missing payments and secure documents needed for posting
• Responsible for managing patient account in processing accounts and working with designated payers to ensure proper reimbursement
• Contacts patient when there is need to update information or COB
• Monitor and Send Claim Files electronically or Paper Claims to Commercial, Medicare and Medicaid
• Track common claims errors, identify and reports inaccurate reimbursement and contractual trends
• Identified billing errors, short payments, overpayments and unpaid claims and resolved them accordingly
• Posts adjustments and collections of Medicare, Medicaid, medicaid managed care and commercial insurance payers
• Contacted responsible payer for status of claim
• Filing appeals for denied claims or claims that requires reconsideration

Revenue Cycle Specialist at Fairview Health Services (2019-05 – 2022-04)

Resolved claim edits and managed healthcare claims through insurance communication and coordination of benefits.

• Resolves claim edits within practice management billing system to ensure successful claim submission
• Daily communication with insurance companies and other commercial insurers to address coordination of benefits and claims resolution
• Reviewed EOBs for correct payment, deductible, adjustments and denials
• Sets follow-up activities based on status of a claim
• Generated receivables reports and offered improvement recommendations
• Reached out to insurance companies to verify coverage
• Work and manage claims from all aging buckets including posting and appeals
• Ability to multitasks and prioritize tasks to accomplish and maintain goals
• Effectively navigate and utilize various healthcare provider software systems
• Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards
• Resolve healthcare claims through verbal or online inquiries to health insurance payers
• Verify accuracy of insurance and patient information
• Verify insurance data entry along with scheduling, and confirming appointments
• Post adjustments and collections of medicare, medicaid, medicaid managed care and commercial insurance payers
• Read and interpret insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and take appropriate steps to resolve issues

Revenue Cycle Specialist at Genesis Medical Center (2016-06 – 2019-04)

Identified and resolved payment issues, managed claim edits, and coordinated insurance benefits across multiple service lines.

• Identified and resolved payment issues between patients and providers
• Resolved system billing and claim WQ edits by working closely with clinical departments, coding staff and registration to assure errors are competed correctly and in a timely manner
• Utilize account information to assist in write-offs for inclusive CPTS by payor
• Communication with insurance payers to ensure proper coverage for patients or to ensure timely and accurate reimbursement for services rendered
• Work with payor throughout the resolution process
• Investigate and coordinate insurance benefits for insurance claims across multiple service lines
• Review and interpret payment information from the EOB (explanation of benefits) to accurately apply payment and adjustment when necessary
• Research denied claims to determine reason for denial by contacting the payor and reviewing the EOBS or R&S

Customer Service Representative at Wipro Technologies (2015-02 – 2016-05)

Handled inbound and outbound calls for 401k participants, processed service transactions and resolved member issues.

• Effectively handled inbound and outbound calls on 401k participants
• Accurately and successfully process service transactions and reached resolution on member issues in a timely and effective manner
• Ability to effectively establish rapport, communicate information and diplomatically respond to inquiries from callers
• Ability to multi-tasks including navigating between computer applications while speaking with participants/payers on the phone
• Tactically handles confrontational or stressful interactions with customers
• Handled customer inquiries and suggestions courteously and professionally
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
• Answered constant flow of customer calls with minimal wait times

Bachelor of Arts in Linguistics – University of Ilorin (2015-08)