Summary
Work History
Education
Skills
References
Timeline
Generic

Yolanda Winston

Denver,CO

Summary

Experienced operations professional with a strong background in claims processing and workflow optimization at Anthem Blue Cross Blue Shield. Track record of improving team performance through effective training and collaboration initiatives. Proficient in problem resolution and compliance assessment, leading to enhanced operational efficiency and service quality.

Work History

Operation Expert National Accounts

Anthem Blue Cross Blue Shield of Colorado
Colorado, Colorado
2013 - 2020
  • Facilitated operational training sessions to boost associate performance and skills.
  • Acted as primary resource for associates regarding workflow and technical inquiries.
  • Provided daily technical support to claims, customer service, and membership teams.
  • Encouraged collaboration among associates to strengthen team dynamics.
  • Monitored inventory levels, ensuring efficient operations without interruptions.
  • Resolved complex cases through in-depth research to tackle difficult challenges.
  • Reviewed compliance metrics related to service level, quality, and productivity for enhancements.
  • Addressed technical inquiries from associates, promoting seamless operational flow.

Dedicated Claims Representative

Google
Colorado, Colorado
2012 - 2013
  • Adjusted health claims per established protocols, ensuring compliance and accuracy.
  • Demonstrated precision in executing complex functions throughout processes.
  • Collaborated on claims workflow projects focused on operational improvements.
  • Analyzed benefits and provider contracts for effective adjudication of claims.
  • Handled void adjustments and reopened claims online to maintain processing integrity.
  • Achieved objectives through independent operation with minimal oversight.
  • Guided staff training efforts and resolved inquiries to bolster team effectiveness.
  • Established close partnerships with Google Employee Service Representatives and Concierge services.

Claims Rep 111- Adjuster

Anthem Blue Cross & Blue Shield of Colorado
Colorado, Colorado
2007 - 2012
  • Executed complex functions that increased efficiency in health claims processing.
  • Managed health claims processing in alignment with established policies and procedures.
  • Interpreted provider contracts and benefits for accurate adjudication of claims.
  • Contributed to workflow projects to enhance claims management practices.
  • Adjusted voids and reopened claims online per adjudication guidelines.
  • Operated independently, ensuring delivery of high-quality results.
  • Trained staff on best practices related to claims inquiries.

UM Specialist System Matter Expert/ Operation Expert/ Trainer

Anthem Blue Cross & Blue Shield of Colorado
2003 - 2006
  • Spearheaded development of structured merge approach utilizing established processes and tools.
  • Created project plans aligned with business objectives to ensure strategic focus.
  • Defined objectives, key issues, methods, performance metrics, resources, timelines, and expected results.
  • Guided strategic direction of projects under IT management supervision for optimal alignment.
  • Tracked project schedules to maintain consistent progress throughout project lifecycle.
  • Composed operational guidelines and job aids to enhance team efficiency.
  • Implemented comprehensive training programs for new hires and refresher courses for Medical Management Associates.
  • Delivered targeted training on applications and mainframe systems used by associates.

UM Specialist Operation Expert

Anthem Blue Cross & Blue Shield of Colorado
2003 - 2006
  • Directed intake staff of 25 associates, optimizing operations and team dynamics.
  • Produced morning and monthly reports to enhance decision-making.
  • Processed daily time sheets for associates, ensuring payroll accuracy.
  • Implemented quarterly reviews focused on employee performance improvements.
  • Collaborated on Human Resource matters, promoting effective solutions.
  • Engaged in annual provider seminars, educating on crucial updates within the community.
  • Crafted operational guidelines and job aids for improved adherence to protocols.
  • Led project management efforts, coordinating tasks and resolving issues promptly.

UM Specialist Intake

Anthem Blue Cross & Blue Shield of Colorado
1999 - 2002
  • Directed management of incoming calls from providers and members about benefit and medical policy regarding authorizations and pre-certifications.
  • Administered provider fax requests to maintain adherence to member benefits.
  • Resolved pended claims through thorough research of payment statuses and corrective processing of errors as needed.

Medicaid/Child Health Plan Enrollment Coordinator

United Health Care
Colorado, Colorado
1998 - 1999
  • Monitored and updated Medicaid membership database to assign physicians based on location.
  • Conducted weekly disenrollment checks to ensure precise membership records.
  • Communicated effectively with corporate office and healthcare entities for coordination.
  • Disseminated membership and capitation details to relevant stakeholders promptly.
  • Evaluated dual eligibility status while offering customer support services.
  • Engaged in meetings regarding Medicaid, Medicare, and Child Health Plan for policy insights.
  • Executed downloading of eligibility and capitation reports for comprehensive record-keeping.

Medicare/Medicaid Insurance Coordinator

Front Range Medical Management
Colorado, Colorado
1995 - 1998
  • Executed payment arrangements and addressed inquiries concerning patient accounts.
  • Conducted posting, coding, and processing of refunds to maintain accurate account oversight.

Education

Bachelor Degree - Langston, Oklahoma

Langston University
Langston, Oklahoma
01.1994

Associates Degree - Denver, Co

Community College of Denver
Denver, Co
01.1992

High School Diploma - Denver, Co

East High School
Denver, Co
01.1990

Skills

  • Claims processing
  • Technical support
  • Compliance assessment
  • Workflow optimization
  • Inventory management
  • Project management
  • Customer service
  • Data analysis
  • Process improvement
  • Problem solving
  • Team collaboration
  • Effective communication
  • Training and development
  • Time management
  • MS office
  • Performance evaluation
  • Leadership
  • Data entry
  • Problem resolution
  • PPE compliance
  • PPE use
  • Team management
  • Analytical thinking

References

Available Upon Request

Timeline

Operation Expert National Accounts

Anthem Blue Cross Blue Shield of Colorado
2013 - 2020

Dedicated Claims Representative

Google
2012 - 2013

Claims Rep 111- Adjuster

Anthem Blue Cross & Blue Shield of Colorado
2007 - 2012

UM Specialist System Matter Expert/ Operation Expert/ Trainer

Anthem Blue Cross & Blue Shield of Colorado
2003 - 2006

UM Specialist Operation Expert

Anthem Blue Cross & Blue Shield of Colorado
2003 - 2006

UM Specialist Intake

Anthem Blue Cross & Blue Shield of Colorado
1999 - 2002

Medicaid/Child Health Plan Enrollment Coordinator

United Health Care
1998 - 1999

Medicare/Medicaid Insurance Coordinator

Front Range Medical Management
1995 - 1998

Bachelor Degree - Langston, Oklahoma

Langston University

Associates Degree - Denver, Co

Community College of Denver

High School Diploma - Denver, Co

East High School

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Yolanda Winston