Yolonda Coney
Jacksonville,FL
Summary
Organized and dependable candidate who is passionate about customer service. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success.
Overview
18
18
years of professional experience
Work History
Benefit Analyst
Florida Blue
07.2013 - 05.2022
- Analyzed and interpreted complex health plan documents, ensuring accurate benefit calculations and adherence to HIPAA regulations.
- Spearheaded a cross-functional team to implement a new claims processing system, resulting in a 30% reduction in processing time.
- Collaborated with medical professionals to enhance medical terminology knowledge and streamline communication with providers.
- Conducted quality assurance reviews and testing to ensure benefits coding validity for Durable Medical Equipment, Home Health, Institutional, and Professional benefits.
- Created and implemented new training initiatives, including online modules, workgroups, and training methods.
- Initiated process improvements, reducing benefit validation processing time by 6%.
- Tracked and resolved issues related to plan setup, benefit clarifications, and changes.
- Provided timely resolutions on complex issues sent to the Manager by various teams and auditors.
Claims/Customer Service Associate
Blue Cross Blue Shield Of Florida
05.2004 - 07.2013
- Process and adjudicate a caseload of over 1,100 commercial paper medical insurance claims per month, working within turnaround times consistently meeting or exceeding productivity and accuracy standard targets.
- Served as a frontline point of contact for policyholders and providers, addressing inquiries and concerns regarding DME and Home Infusion benefits, claim status, and eligibility; achieving a customer satisfaction rating of 95%.
- Provided quality, timely, and efficient support and services, consistently exceeding quality assurance standards.
- Worked independently within stringent time frames and in accordance with CMS guidelines.
- Demonstrated extensive knowledge of pricing and reimbursement methodologies.
- Consulted with policy holders and providers regarding their needs and addressed concerns while upholding privacy and security requirements.
- Offered Subject Matter Expert support on multiple projects and workgroups.
- Facilitated communication with internal and external partners via written and verbal communication.
Education
High School Diploma -
Nathan B Forrest
Jacksonville, FLSkills
- Claims Processing: Proficient in processing health insurance claims with a strong understanding of ICD-9/ICS-10, CPT, and HCPCS coding
- Customer Service: Exceptional verbal and written communication skills, with a proven track record of maintaining high customer satisfaction
- Problem-Solving: Successfully resolved complex claims and discrepancies, contributing to improved efficiency
- Adaptability: Thrived in a dynamic, fast-paced environment with fluctuating workloads in office and remotely
- Training and Leadership: Conducted training sessions and led cross-functional teams to achieve departmental goals
- Technology: Proficient in Microsoft Word, Excel, and Outlook and systems used in the healthcare insurance industry with strong data entry skills
Timeline
Benefit Analyst
Florida Blue
07.2013 - 05.2022
Claims/Customer Service Associate
Blue Cross Blue Shield Of Florida
05.2004 - 07.2013
High School Diploma -
Nathan B Forrest
Similar Profiles
Christina FredericChristina Frederic
Medicare Appeals & Grievances Coordinator at Florida Blue - Blue Cross Blue Shield Of FloridaMedicare Appeals & Grievances Coordinator at Florida Blue - Blue Cross Blue Shield Of Florida
Abdo TaressaAbdo Taressa
Customer Service Representative at Florida Blue - Blue Cross Blue Shield Of FloridaCustomer Service Representative at Florida Blue - Blue Cross Blue Shield Of Florida
Kristen BrackmannKristen Brackmann
Customer Service Advocate at Blue Cross Blue Shield of Florida, Florida BlueCustomer Service Advocate at Blue Cross Blue Shield of Florida, Florida Blue
Heath WesenbergHeath Wesenberg
Business Support Analyst II at Florida Blue - Blue Cross Blue Shield Of FloridaBusiness Support Analyst II at Florida Blue - Blue Cross Blue Shield Of Florida
Destiny FieldsDestiny Fields
Fraud Operations Specialist at CitibankFraud Operations Specialist at Citibank