Open to opportunities

Ola Ola

@olaola2

Compliance and revenue-cycle professional specializing in utilization management, coding accuracy, and claims & appeals under CMS and HIPAA.

United States

Message

What I'm looking for

I’m looking for a compliance/revenue-cycle role where I can strengthen utilization management, medical necessity reviews, denial/appeals workflows, and audit readiness—partnering with clinical and operations teams to reduce regulatory risk and improve reimbursement outcomes.

I’m a healthcare compliance and revenue cycle professional with 7+ years of experience across utilization management, medical necessity review, clinical claims adjudication, denial management, and government-regulated program oversight. I bring a detail-driven approach to protecting member outcomes while ensuring payer and regulatory alignment.

I apply MCG/InterQual criteria and coding standards (ICD-10-CM/PCS, CPT, HCPCS) within CMS, HIPAA, and Medicaid/Medicare frameworks. From prospective, concurrent, and retrospective claim reviews to DRG validation and itemized bill review, I focus on accuracy, appropriate level of care, and defensible clinical documentation.

I’ve led medical review and appeals workflows, including prior authorization appeals and corrective resubmissions for coding and medical necessity issues. I also support grievances, administrative fair hearings, and post-payment audit readiness by tracking defect trends and preparing cases with clear, evidence-based clinical criteria.

Beyond revenue cycle, I’ve supported compliance and regulatory risk management through surveillance reviews, audit-ready documentation, and internal control framework development. I’m currently pursuing the CPC credential through AAPC, and I’m committed to regulatory awareness, ethics, and accountability in every engagement.

Experience

Work history, roles, and key accomplishments

Current

Independent Contractor

Current

Amazon Flex

Dec 2025 - Present (7 months)

Provided independent delivery services through Amazon Flex while pursuing CPC certification and professional development in healthcare administration, claims, appeals, utilization/denial management, and healthcare compliance.

Independent Contractor Delivery CPC Certification (AAPC)ICD 10 CM PCS CPT HCPCS Medicare Medicaid Medical Necessity Review Utilization Management Denial Management Healthcare Compliance Regulatory Requirements Claims Adjudication Workflows Appeals Processes Provider Relations Healthcare Operations

Compliance Analyst (Surveillance)

Deloitte

Apr 2025 - Nov 2025 (7 months)

Supported compliance and regulatory risk management for government-aligned programs, including surveillance reviews and audit-ready documentation. Assisted with regulatory inquiry/audit responses and internal control framework development.

Compliance Monitoring Regulatory Risk Management Audit Support Surveillance Reviews Internal Controls Compliance Testing

KYC / Compliance Analyst

One Florida Bank

Nov 2024 - Feb 2025 (3 months)

Conducted KYC and due diligence reviews and maintained audit-ready documentation for regulatory examinations. Monitored adherence to state and federal financial compliance standards.

KYC Due Diligence Financial Compliance

Customer Service Representative

Amtrak

Jan 2023 - Nov 2024 (1 year 10 months)

Ensured compliance with ADA requirements, federal safety regulations, and Amtrak operational policies by escalating potential violations and documenting incident reports. Coordinated passenger accommodation needs with operations and accessibility teams.

ADA Compliance Disability Accommodations Incident Reports Quality Assurance Documentation Escalation Handling

Customer Service Rep - Claims & Billing

Dialog Direct / Blue Cross Blue Shield

Jan 2019 - Jan 2023 (4 years)

Adjudicated and reprocessed outpatient professional and facility claims using CMS, HIPAA, and payer guidelines. Performed medical necessity/utilization management reviews and managed denials through appeals workflows.

CPT Coding HIPAA compliance Utilization Management Concurrent Review Retrospective Review Denial Management Denials Appeals Outpatient Claims DRG Validation

UM Coordinator & Medical Review

Chicago Lakeshore Hospital

Jan 2017 - Jan 2019 (2 years)

Performed prospective, concurrent, and retrospective utilization management reviews to validate medical necessity and level of care using MCG/InterQual criteria. Supported prior authorization appeals and prepared cases for administrative and judicial fair hearing proceedings.