Summary
Overview
Work History
Education
Skills
Timeline
Generic

YaQuin Starks

Memphis,TN

Summary

Dedicated and skilled professional with over 25 years of Reimbursement experience. A resolute and focused Prior Authorization Manager with over 25 years’ professional experience across healthcare industry and educational institutes. Adept at applying skills in development of data solutions that enable organizations to make data-driven decisions, deliver real-time analytics, and enhance clinical operations & deployments. An expert in SAP with a background in technical operations and systems: has proven ability to enhance and streamline processes, and work collaboratively with multiple, cross-functional teams across organizations. Served as the Program Administrator for Exogen Operation and Governance Committee. Developed policies and procedures for the Exogen process. Implemented policy changes and training for the Exogen process. Proven capacity to develop a clear understanding of healthcare-oriented needs and turn these into workable technical solutions. A self-motivated and results-driven individual, who has excellent IT skills, analytical thinking and thrives on challenges. Skilled in Medicaid, U.S. Health Insurance Portability and Accountability Act (HIPAA), Medicare, Prior Authorization, and Medical Billing. Supports concurrent & complex projects, with a passion for delivering high-standard services, to ensure stakeholder satisfaction. Served as Insurance Claims Processor for 3 years, Internal Reimbursement Specialist for 8 years. Supervisor of Reimbursement Services for 12 years, Program Administrator for 2 years, and Manger of Reimbursement Services for 1 year. Previous experience includes training Reimbursement Specialist and Sales Representatives on the reimbursement process. Also, experience in Customer Service and Claims Processing. ‘Driven and inquisitive; brings a can-do attitude and passion for new challenges and learning.’

Knowledgeable Field Reimbursement Management with strong background in managing channel partnerships and driving revenue growth. Successfully developed and executed strategic plans that enhanced partner engagement and optimized sales performance. Demonstrated ability in fostering collaborative relationships and leveraging market insights to achieve business goals.

Results-driven professional prepared for this role. Strong background in driving channel strategy, optimizing sales performance, and building solid partner relationships. Known for fostering team collaboration and adapting to evolving business needs. Skilled in strategic planning, negotiation, and stakeholder management with focus on achieving measurable results.

Experienced with developing and managing channel strategies to maximize partner potential. Utilizes strong relationship-building skills to foster productive partnerships and drive mutual growth. Track record of implementing effective sales initiatives and optimizing channel performance to meet business objectives.

Results-driven sales professional prepared for role, bringing wealth of experience in channel management and strategic planning. Proven track record of building robust partner networks and implementing strategies that drive business success. Emphasizes team collaboration and adaptability, ensuring alignment with evolving market demands. Known for exceptional negotiation skills and keen focus on achieving results.

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.

Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.

Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.

Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

17
17
years of professional experience

Work History

Government Channel Manager Reimbursement Services

Bioventus
Cordova, TN
05.2022 - 10.2025
  • Responsible for managing the Government Channel Team, which consists of Medicare, Managed Medicare, Medicaid, Managed Medicaid, Tricare, VA, and Work Comp/Auto claims. Responsible for ensuring the team is adhering to the coverage guidelines of each plan. Reviewing audit results from QC to team and providing education and feedback to the MAS’. Monitor Service Level agreements and other staffing issues. Partner with Field Sales Team to ensure that they are providing additional documentation in a timely manner. Field rides with Territory Managers to answer any questions or concerns their offices may have regarding Insurance coverage in their territory. Observe the Sales Reps to ensure that they are getting all the proper paperwork to submit a clean claim. Handling escalations regarding coverage criteria questions from key business partners. Educating both direct reports and Sales Reps working directly in the field with the HCP offices. Also responsible for reviewing and updating Medicare’s coverage policy based on results from the Auditors. Recent added duties include Managing the entire Reimbursement Department (Medicare, Work, Comp, & Commercial Team) with all daily tasks.

Program Administrator for Exogen Governance

Bioventus
Cordova, TN
09.2020 - 04.2022
  • Led cross-functional teams to enhance program workflows and improve overall efficiency.
  • Developed and implemented training programs for staff, increasing knowledge retention and operational effectiveness.
  • Managed budget allocations for multiple projects, ensuring adherence to financial guidelines and resource optimization.
  • Analyzed program performance metrics to identify areas for improvement and drive strategic decision-making.
  • Coordinated communication between departments, fostering collaboration and alignment on project objectives.
  • Streamlined reporting processes, enhancing data accuracy and accessibility for stakeholders across the organization.
  • Developed and implemented training initiatives to enhance team performance and operational efficiency.
  • Analyzed program data to identify trends, driving informed decision-making for process improvements.

Supervisor of Reimbursement Services

Bioventus
Cordova, TN
03.2012 - 08.2020
  • Supervised daily operations to ensure compliance with quality standards and safety regulations.
  • Developed training programs for new staff, enhancing team performance and retention rates.
  • Implemented process improvements that increased operational efficiency across departments.
  • Coordinated inventory management systems, optimizing stock levels and reducing waste.
  • Analyzed workflow processes, identifying areas for enhancement and streamlining operations.
  • Fostered a culture of continuous improvement through regular staff feedback sessions and performance reviews.
  • Managed conflict resolution among team members, promoting a collaborative work environment.
  • Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.

Supervisor of Reimbursement Services

SMITH & NEPHEW, INC
Memphis, TN
01.2009 - 01.2012
  • Supervised the Reimbursement Team, which included Reimbursement Specialist, Patient Advocate Specialist, and Data Entry/Master Data Clerks. Data Entry Clerks were responsible for creating new orders and physician accounts and assigning them to the Sales Team. Performed in-services with our Cost Containment Vendors. Also was part of CEO presentations.
  • Internal Reimbursement Specialist- 2001-2009
  • Responsible for verifying insurance coverage, reviewing clinical for supporting documentation, submitting, and reviewing clinical for prior authorization, and following up with Insurance carrier for determination of claim. Reviewing orders for medical necessity based off Medical Plan’s Published Medical Policy. Appealing claims which denied in error. Getting patients to agree to their out-of-pocket expense.
  • Key Achievements:
  • Researched, tested, and implemented new system enhancements, including:
  • Paperless order processing
  • EPrescription order submission
  • Blueprint for Bioventus systems
  • Successfully implemented Payer Lane structure to Reimbursement Services. This divided the department into 6 teams: 3 Regional Teams (East, Central, and West), Medicare Team, Work Comp/Auto Team, and National Payer Team (Humana, UHC, Aetna, and Cigna). This aided in us achieving our three SLA’s:
  • 85% of orders Benefits Investigation conducted in less than 24 hours.
  • 95% Internal Review conducted in less than 24 hours.
  • 85% Additional Paperwork processed in less than 24 hours.
  • Because of achieving this SLA’s, sales have increased to 111.4 million and conversion rate has increased by 3%.
  • Named Internal Reimbursement Specialist of the Year, 2007
  • Won 2012 CEO Award for extraordinary contributions to the success of Bioventus
  • Part of the Brightree Implementation Team

Education

MBA - Concentration Project Management

Strayer University
Memphis, TN

Skills

  • Staff Development & Training
  • Strategic Direction & Reporting
  • Process Reengineering
  • Communication & Negotiation
  • Data Analysis & Reporting
  • Resource Management
  • Process & Data Modeling
  • Data Visualization & Architecture
  • Stakeholder Engagement
  • Clinical Technology & Systems
  • Risk Mitigation
  • Performance Optimization
  • Insurance Verification HIPAA
  • Coding
  • Operational Excellence
  • Research, Analysis, & Advisory
  • Prior Authorization Submission
  • Compliance & Regulation
  • Digital Healthcare Practices
  • Medical Necessity Review
  • Accounts Payable/Receivable
  • Project Lifecycle Management
  • Medical Policy Review
  • Workers’ Compensation
  • Negotiation
  • Account management
  • Strategic partnerships
  • Data analysis
  • Teamwork and collaboration
  • Problem-solving
  • Time management
  • Problem-solving abilities
  • Reliability
  • Team leadership
  • Active listening
  • Adaptability and flexibility
  • Verbal and written communication
  • Decision-making
  • Self motivation
  • Product knowledge
  • Client relationship management
  • Analytical thinking
  • Operations management
  • Sales process
  • Goal setting
  • Professionalism
  • Analytical problem solver
  • Staff supervision
  • Time management abilities
  • Continuous improvement
  • Adaptability
  • Team recruiting and onboarding

Timeline

Government Channel Manager Reimbursement Services

Bioventus
05.2022 - 10.2025

Program Administrator for Exogen Governance

Bioventus
09.2020 - 04.2022

Supervisor of Reimbursement Services

Bioventus
03.2012 - 08.2020

Supervisor of Reimbursement Services

SMITH & NEPHEW, INC
01.2009 - 01.2012

MBA - Concentration Project Management

Strayer University
YaQuin Starks