Quendolyn Maye
Healthcare
Little Elm,TX
Summary
Qualified [Desired Position] with comprehensive background as Benefits Specialist. Demonstrated ability to streamline benefits administration, enhancing employee satisfaction and compliance. Proven skills in communication and problem-solving have been pivotal in resolving complex benefits issues efficiently.
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
19
19
years of professional experience
Work History
Verification of Benefits Specialist
Mindlance
07.2024 - 07.2025
- Knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review.
- Experience in medical device or DME Billing a plus
- Proficient with Microsoft Office (Word & Excel specifically)
- Medical billing software experience a plus
- Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding)
- Ability to accurately meet required time frames/deadlines
- Ability to work as a team player and share workloads with other team members
- Excellent verbal and written communication skills
- Ability to train/present concepts to others
- Has worked in a physician's office
- Strong communication skills
- Strong organizational skills
- Understanding co insurance and benefit understanding
Benefits Verification Specialist
Mindlance
07.2024 - 06.2025
- Assisted clients with resolving complex benefits issues, improving overall customer satisfaction.
- Assisted in the development of new benefits verification procedures, ensuring a smooth transition for team members during implementation stages.
- Safeguarded confidential client information by adhering to strict privacy guidelines and protocols.
- Increased accuracy in verifying patient eligibility through diligent cross-checking of multiple databases before finalizing claim submissions.
- Established positive relationships with insurance carriers, streamlining communication channels when clarifying policy details or negotiating terms on behalf of clients.
- Collaborated with healthcare providers to ensure accurate billing and benefit coverage information.
- Enhanced claim processing efficiency by reviewing and verifying insurance benefits information.
Patient Services Specialist II
Baylor Scott and White Health
07.2023 - 03.2024
- The Patient Services Specialist 2 provides administrative help in a physician office, clinic or other operational area that assists patients, to ensure high quality, patient-centered care.
- Assists patients and other visitors by performing patient related duties to include check-in or check-out, scheduling, insurance verification also answering inbound calls, in regard to appointment and benefit coverage inquiries.
- Prior Authorization processing
- Insurance Benefits Verification
- Medical Doctor Referrals
- Registers patients by collecting and verifying insurance information.
- Verifies patient demographics and enters changes for correct processing of claims for payment.
- Directs patients to appropriate waiting areas. Accepts payments for physician/clinic services according to established guidelines.
- Posts payments and enters charges to utilize medical appropriate codes for claim submittals. Provides accurate patient, medical, financial or procedural information to patients or approved outside entities.
- Offer and update financial arrangements with patients. Responds to routine escalated inquiries concerning services, hours of operation, etc.
- Resolve any patient complaints appropriately. Assists with medical records duties by pulling charts for scheduled walk-in appointments, prescription refills and other requests.
- Retrieves, transports, sorts and files medical records. Copies medical records chart for patient transfers and referrals.
Patient Access Consultant II
AmerisourceBergen
01.2019 - 07.2022
- Billing and coding support
- Claims assistance, tracking and submission.
- Prior authorization assistance and tracking
- Coordination of benefits
- Benefit verification result call.
- Appeals/Denials
- Determination for support programs (Copay, PAP, Medicaid, etc.)
- Intakes and reports adverse events as directed.
- Responsible for coordination of services with field reimbursement teams and sales representatives.
- Independently analyzes, reports, resolves, and communicates any reimbursement trends/delays.
Benefit Liaison
Paragon Healthcare
02.2018 - 01.2019
- Intake of PCP Referrals for infusion services.
- Provided members explanation of benefits for insurance coverage.
- Worked with infusion pharmacist with estimates for billing of in-home infusion.
- Operate CPR system for patient's demographics and insurance benefits.
- Process research for doctor's information and updated contact on physician's referrals.
- Advised patients of the process In Network & Out of network coverages for their medical plan.
- Handled inbound calls from PCP Referrals agent for prior authorization.
Insurance Benefit Coordinator
Cardinal Health
09.2015 - 06.2017
- Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
- Operates a PC/image station to obtain and extract information, documents information, activities and changes in the database.
- Develops and maintain positive relationship with medical and pharmacist for Medicare members.
- Provides external and internal customers with prior authorization request.
- Receives and places follow-up telephone calls / e-mails to answer Medicare inquiries.
- Uses computerized systems for tracking, information gathering and troubleshooting.
Prior Authorization Insurance Specialist
Anthem/Amerigroup
02.2013 - 07.2015
- Handle inbound/outbound provider and member calls by resolving member inquiries, explanations of payments, claim status, plans and benefits.
- Assist physician/members with benefit and eligibility information on Medicare & Commercial plans.
- Communicate effectively with other departments and providers to ensure prompt and accurate resolution of calls.
- Performs other special projects, related duties and responsibilities as assigned which included activating prior authorization for members based on medical plan coverage.
- Provided information regarding billing issues, and medical claims updates to the member coverage information and prescription records.
Insurance Benefit Specialist
Express Scripts (Medco Health Solution)
02.2006 - 04.2012
- Handle incoming provider and member calls
- Handle inquiries, explanations of payments, claim status, plans and benefits- through inbound calls
- Appropriately identifies issues requiring escalation, referral to another functional area and/or submission for the grievance process
- Assist clients/members with benefit and eligibility information on Medicare & Commercial plans.
Education
High School -
South Grand Prairie High School
Grand Prairie, TexasSkills
- Excellent written and verbal communication skills Liaison between providers, internal departments for accounts, clients and claims department Flexible in adapting to change Manage patient intake and onboarding, accurately documenting cases in the CRM system Expert understanding Commercial, Medicaid and Medicare claims coding Expert understanding of call center metrics (ASA, AHT, Abandonment rate, Quality Score Card), professional telephone etiquette
- Deliver personalized support and education to patients and their caregivers, adjusting communication to their preferences
- Respond to inquiries from patients and healthcare providers according to established protocols
Timeline
Benefits Verification Specialist
Mindlance
07.2024 - 06.2025
Verification of Benefits Specialist
Mindlance
07.2024 - 07.2025
Patient Services Specialist II
Baylor Scott and White Health
07.2023 - 03.2024
Patient Access Consultant II
AmerisourceBergen
01.2019 - 07.2022
Benefit Liaison
Paragon Healthcare
02.2018 - 01.2019
Insurance Benefit Coordinator
Cardinal Health
09.2015 - 06.2017
Prior Authorization Insurance Specialist
Anthem/Amerigroup
02.2013 - 07.2015
Insurance Benefit Specialist
Express Scripts (Medco Health Solution)
02.2006 - 04.2012
High School -
South Grand Prairie High School
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