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Lydia OrogunFrisco, TX Street Address   PHONE NUMBER AVAILABLE  EMAIL AVAILABLEProfessional SummaryA Revenue cycle specialist with superior skills working in both team base and independent capacities, and in-depth understanding of follow-up and billing procedures bringing forward years of experience, expertise on insurance claim management, reducing denials and improving revenue outcomes. SkillsRevenue collection report preparation Coordinating Documents Accurate Notations Strong attention to details and accuracy Maintaining detailed records Claims reviewVerifying Insurance Ability to independently identify areas of concern regarding various areas of revenue cycleInsurance follow up Healthcare billing proficiency Customer service Proficient in Microsoft word, Excel and outlookWork HistoryRevenue Cycle Specialist, 04/2022 to 06/2024Cornerstone Healthcare Group Holding  RemoteFollowing up on unresolved claims and working denials to resolution. Utilizing payer portals and phone calls to get claim status patient accounts. Performing account follow-up activities on high-dollar and aging accounts. Identifying technical and Clinical denials and working them to resolution Appropriately. Reduced outstanding account balances by implementing effective collection strategies. Resolved complex payment issues such as denials, underpayments or incorrect coding. Works all assigned insurance payers to ensure proper reimbursement on patient accounts to expedite resolution.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. Processes medical, administrative, technical appeals, request refunds when applicable, and rejections of insurance claimsTrack routine follow up with payers to ensure reimbursement of billed claims Determine most efficient process to resolve refund requests or credit balance. Initiate patient outreach on delinquents payments for patient responsibilities on claims Recognizes potential issues within claims and collections process and recommends and implements solutions for improvementResearch missing payments and secure documents needed for posting. Follow up with payers to ensure timely resolution of all outstanding claims, via phone calls, payer portals review, fax or websites.Responsible for managing patient account in processing accounts and working with designated payers to ensure proper reimbursementContacts patient when there is need to update information or COB Monitor and Send Claim Files electronically or Paper Claims to Commercial, Medicare and MedicaidTrack common claims errors, identify and reports inaccurate reimbursement and contractual trends Identified billing errors, short payments, overpayments and unpaid claims and resolved them accordinglyPosts adjustments and collections of Medicare, Medicaid, medicaid managed care and commercial insurance payersContacted responsible payer for status of claimFiling appeals for denied claims or claims that requires reconsideration Revenue Cycle Specialist, 05/2019 to 04/2022Fairview Health Services  RemoteResolves claim edits within practice management billing system to ensure successful claim submissionDaily 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 payersRead and interpret insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and take appropriate steps to resolve issues. Revenue Cycle Specialist, 06/2016 to 04/2019Genesis Medical Center  Dallas, TXIdentified 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 processInvestigate 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, 02/2015 to 05/2016 Wipro Technologies  Plano, TXEffectively 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 mannerAbility to effectively establish rapport, communicate information and diplomatically respond to inquiries from callersAbility to multi-tasks including navigating between computer applications while speaking with participants/payers on the phoneTactically 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. EducationBachelor of Arts: Linguistics, 08/2015University of Ilorin - Kwara State, Nigeria