Yolanda M. Castille
Baytown,Tx
Summary
My skills and years of experience demonstrate my commitment to supporting organizational goals through research and effective problem-solving.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Medicare & Retirement Navigator, C&S DSNP Navigator, Compliance Champion Retail Escalation Team
UnitedHealthcare
03.2022 - Current
- Help close gaps in care by scheduling appointments, prescription refills and healthcare follow-ups. Also, by staying actively involved in the members health. Quote benefits, explain monthly premiums, deductions and assist with payments. Assist with resolving billing disputes. Research, reviewing and explaining claims processing. Confirming claims has been processed properly.
- Manage member calls inbound and outbound regarding plan benefits for medical, dental, vision hearing. Assist members with prescriptions needs, escalated concerns and Social Determinants of Health. Complete assessments to determine members needs. As an advocate there is not a limit with addressing members needs.
- Work with external partners to schedule appointments and to assist with required DME request.
- Identify prior authorization filing. Submit and provide status on appeals and grievances.
- Schedule transportation through SafeRide portal for members.
- Assist with scheduling house call visits for nurse practitioners.
- POC for a complex special needs member that requires an aide for one-on-one. TennCare Medicaid.
- As a compliance champ review compliance before submission and coach peers. Also, educate the team about upcoming changes regarding compliance and CMS changes.
- Facilitate compliance clinic meetings
- Supported hotline for Change Health Care regarding questions about system breach.
- Work with C&S Retail Escalation Team on escalated cases for members that needs immediate assistance.
Chase Private Client
JP Morgan Chase
05.2018 - 12.2021
- Excel at providing end-to-end customer support including answering questions, explain details of account transactions, assist with self-service, account updates, and providing online support using purposeful approach. Served as POC on the team.
- Interim Team Leader
- Provided leadership and support for existing supervisors that were out on leave of absence or vacation.
- Served as the subject matter expert for the team and provided coaching, training, facilitate meetings and call monitoring for quality.
- Communicated effectively through instant messenger and zoom with those who worked remotely and in the office.
- Peer Coach
- Provide assistant to the trainer for new hires. Assist with system access, basic troubleshooting, answering questions, monitor calls to provide feedback.
Team Leader-Help Desk
Acadian Ambulance/Acadian on Call
06.2013 - 05.2018
- Accountable for researching, troubleshooting, and resolving customer and employee issues. Data entry support as required.
- Partnered with field technicians on ordering medically necessary equipment, scheduling appointments, and following up with customers to ensure needs are met.
- Served as the crucial point of contact for the team answering complex questions, resolve escalated calls, and provide new hire training for new employees.
- Alarm Dispatcher
- Monitored medical, fire and burglar alarms and dispatching emergency responders when intervention is needed.
- Accountable for providing customer account support for sales staff.
Education
Bachelor of Science - Information Technology-Data Analytics and Artificial Intelligence
Associate degree - undefined
Microcomputer Software at Microcomputer Technology Institute
Skills
- Leadership
- Customer Service & Relations
- Banking & Finance
- Training and Instruction
- Relationship Building
- ATS Tracking
- Prior Authorization System (PAS)
- FACETS
- GPS
- NICE
- Knowledge Central
- MACESS
- DMEVS
- Solutran Program Sponsor Portal (PSP)
- Customer Relationship Mgmt (CRM)
- Complex Resolution
- Grievance and Appeals
- Troubleshooting & Resolution
- Data Entry
- Microsoft Excel
- Microsoft Word
- Microsoft PowerPoint
- Compiler Platform Analyzer
- RX Claims
- Medical Terminology
- ICUE
- Maestro
- Qfinity
- MARx (CMS)
- SafeRide Portal
- House Calls scheduling portal (PCSS Tool)
- Call monitoring
- CMS portal
- Provider Contract System
- Quality Analyst
Certification
- Google Certificate - Foundations of Project Management
- Google Certificate-Project Initiation Starting a Successful Project
- Rice University Certificate-Medical Terminology Specialization
- Medicare & Retirement 1-3
- Compliance Champion
- NPS Champion
- Culture Core Ambassador
- Black Experience Employee Resource Group
- Amplify Group
- Employee of the month February 2025
Timeline
Medicare & Retirement Navigator, C&S DSNP Navigator, Compliance Champion Retail Escalation Team
UnitedHealthcare
03.2022 - Current
Chase Private Client
JP Morgan Chase
05.2018 - 12.2021
Team Leader-Help Desk
Acadian Ambulance/Acadian on Call
06.2013 - 05.2018
Associate degree - undefined
Microcomputer Software at Microcomputer Technology Institute
Bachelor of Science - Information Technology-Data Analytics and Artificial Intelligence
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