Summary
Overview
Work History
Education
Skills
Activities
Timeline
Generic

YOLANDA VAUGHN

Florissant,MO

Summary

Extensive Patient Accounting and Health-care industry experience in billing, EMR, processing claims, auditing, and collection of revenue. Extensive knowledge in McKesson / HBOC/EPIC. Extensive customer service experience (phone & face to face contact). Great working paced environment demanding strong organizational, technical and interpersonal skills. Leadership abilities including monitoring productivity and counseling employees of work ethics. Diligent, detail-oriented person and knowledgeable of all office functions. Multi-tasking in a fast paced environment, completing projects within a timely manner, and budget constraints. Working with physicians to update credentialing information so that claims can go out without getting denials for non-credentialing.

Offering compassionate and patient-focused approach with readiness to learn and grow in healthcare environment. Brings understanding of healthcare landscape, delivering strong communication and problem-solving skills.

Educated and dedicated to providing assistance to individuals and families in need. Proficient in assessing individual circumstances, identifying resources and developing plans of action to deliver support. Proven ability to work independently and collaboratively with diverse stakeholders.

Healthcare professional, prepared for role requiring expertise in patient navigation. Supported patients in accessing healthcare services and navigating complex systems. Known for collaboration, reliability, and adaptability with strong focus on patient advocacy and resource management.

Overview

19
19
years of professional experience

Work History

Health Navigator

United Healthcare
07.2021 - Current
  • Educated patients and families on available resources, empowering them to make informed decisions about their care.
  • Maintained detailed documentation of patient interactions, treatment plans, and progress notes for accurate recordkeeping.
  • Streamlined healthcare services by effectively collaborating with interdisciplinary teams.
  • Conducted comprehensive assessments of patient needs, developing individualized care plans accordingly.
  • Improved patient adherence to treatment plans through ongoing support and education efforts.
  • Served as a reliable resource for colleagues seeking guidance on challenging situations or unfamiliar aspects of care navigation.
  • Developed strong relationships with community partners, enhancing the referral network for patients in need of specialized services.
  • Identified potential barriers to care, implementing tailored solutions to improve outcomes.
  • Consistently maintained confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
  • Assisted members with social determinants of health and linked to appropriate community resources.
  • Provided emotional support to patients and families during difficult times, fostering trust and rapport within the therapeutic relationship.
  • Enhanced patient satisfaction by providing comprehensive care coordination and support.
  • Educated member on gaps in care and assisted with scheduling provider appointments.
  • Verified patient insurance eligibility and entered patient information into system.
  • Advocated for patients'' best interests when working with insurance companies or other external entities involved in their care process.
  • Promoted a positive work environment among peers by remaining approachable, supportive, and flexible when collaborating on shared tasks.
  • Utilized Microsoft Word to edit, create and save confidential documents.

Customer Service Representative

Teleperformance USA
07.2018 - 07.2021
  • Met customer call guidelines for service levels, handle time and productivity.
  • Followed up with customers about resolved issues to maintain high standards of customer service.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Assisted customers in navigating company website and placing online orders, improving overall user experience.
  • Increased efficiency and team productivity by promoting operational best practices.
  • Exhibited high energy and professionalism when dealing with clients and staff.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.
  • Calculated correct order totals, updated accounts, and maintained detailed records for inventory management.

Medical Biller / Medicaid Specialist

SSM Health
05.2006 - 07.2018
  • I follow up on medical claims after Medicaid primary and secondary
  • I bill medical claims to Medicaid
  • I check Medicaid website to see if claims are paid correctly and if claim is pending for other information
  • I manually key claims on the Medicaid website
  • I review denials of claims and submit all needed information to get correct payment
  • Work with un-credentialed doctors making sure that all information gets updated and get unprocessed claims are-processed
  • Conducted regular audits of billing records to ensure accuracy and completeness, enhancing overall financial performance for the practice.
  • Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
  • Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
  • Liaised between patients, insurance companies, and billing office.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Verified accuracy of accounts payable payments, resulting in [Number]% reduction in payment errors and check reissues.
  • Reviewed patient records, identified medical codes, and created invoices for billing purposes.
  • Posted payments and collections on regular basis.
  • Communicated with insurance providers to resolve denied claims and resubmitted.

Education

NON - Business Management

MANSFIELD BUSINESS COLLEGE
St Louis, MO
09.1987

Diploma - Business

BEAUMONT HIGH
St Louis, MO
05.1987

Skills

  • EPIC
  • Maestro
  • CRM
  • Microsoft
  • HIPAA
  • Billing
  • Hospital and Physician Claims Follow Up
  • Credetntialing
  • Patient confidentiality
  • Care coordination
  • Resource navigation
  • Healthcare systems
  • Community resources
  • Insurance expert
  • Teamwork
  • Time management
  • Attention to detail
  • Problem-solving abilities
  • Multitasking Abilities
  • Reliability
  • Verbal and written communication
  • Patient education
  • Patient support
  • Written communication
  • Client needs assessment

Activities

  • Volunteered to do team lead work in my department because it wasn't in the budget to hire one.
  • Stepped up to help others complete projects.

Timeline

Health Navigator

United Healthcare
07.2021 - Current

Customer Service Representative

Teleperformance USA
07.2018 - 07.2021

Medical Biller / Medicaid Specialist

SSM Health
05.2006 - 07.2018

NON - Business Management

MANSFIELD BUSINESS COLLEGE

Diploma - Business

BEAUMONT HIGH
YOLANDA VAUGHN