Summary
Overview
Work History
Education
Skills
References
Keywords
Timeline
Generic

YONIQUE FENTRESS

HAMPTON ROADS ,Virginia

Summary

To utilize education, skills and experience to obtain the applied position.

Overview

30
30
years of professional experience

Work History

Reimbursement Analyst - Claims Analyst

ANTHEM
01.2017 - Current
  • Communicate, research and follow administrative policies.
  • Process reimbursement disputes of payment.
  • Adjusting payout amount when errors or update are found in pricing.
  • Resolve disputes and meet quality, service level agreements and production set according to each State.
  • Collaborate periodically with outside business partners & vendors when settling a dispute.
  • Review and writing decision based on findings.
  • Pay attention to details and reason for denials to determine if decision will be overturned.
  • Perform verification, check Provider’s credentials and specialty for billing.
  • Take actions to complete cases assigned.
  • Research, investigate and follow administrative policies and procedures and use as tool for guidance when making decision and resolve cases.
  • Work remotely.
  • Attend weekly/team meetings, scheduled one on ones, training monthly manager and inventory meetings including quarterly Townhall meetings virtually.
  • Meet monthly SLAs (Service Level Agreements) of the client.
  • Provide written electronic correspondence of decisions.
  • Request info for follow up and incomplete/pending disputes.
  • Note failure to follow protocol on requesting payor that could have contributed to delay or denial of pay.
  • Provide efficient, thorough fact findings of investigation of reviewed disputes, including billing errors made in coding.
  • Request submission of additional proof/supporting documents to complete investigations when missing info.
  • Inquire of specifics detailed invoices billing for service to verify pricing is within range for a payout and is validated a good cause for the scope of the dispute filed.
  • Review, coordinate insurance benefits paid and the difference of allowed to ensure no duplicate payments and correct payments sent.
  • Request recoup of overpaid service has occurred.
  • Verify no denials, proper billing, and authorizations match service rendered.
  • Perform functions such as calculations, check contract pricing agreement on equipment, service, procedures, transportation and prescriptions billed.
  • Determination based on accurate measures if Provider is in network with contractual agreements as well as if Provider has no agreement but approved by case by case bases.

Technical Support

01.2009 - 12.2016
  • Respond to chats, emails & phone calls.
  • Diagnose problems.
  • Troubleshoot.
  • Assist online account, billing disputes, password resets, registration for new accounts.
  • Assist users with navigation on company’s website/mobile apps.
  • Explain install steps of software/programs.
  • Increase sales & upgrades.
  • Use analytical skills to determine and resolve hardware/software service issues.
  • Follow up with clients/customers.
  • Log case notes.
  • Provide excellent customer service.

Healthcare/Admin - Claims - HR Benefits Specialist - Medicare Specialist

EDS
01.2002 - 05.2008
  • Calculate pay for eligible retirees.
  • Determine eligibility for pay.
  • Review and process claims from providers and employers.
  • Coordinate commercial insurance with Medicare/Medicaid/supplemental insurance or private insurance.
  • Research to verify annual enrolled benefit elections selected complete and how to utilize when enrolled inquires including qualifying life event changes.
  • Accountability of working cases assigned.
  • Sending packets and forms to requesting individuals, verify/authenticate callers.
  • Read and Input info to records of financial payment(s).
  • Calculate premium cost and out of pocket expenses per pay period.
  • Exhibit attention to great detail to organize workload.
  • Prioritize work.
  • Log case notes with actions taken and record findings on each case.

Office Manager

HAMPTON INN & CALL CENTER MCI
01.1996 - 12.2001
  • Disciplinary of policy and procedure broken/not followed by either verbal warning, coaching to develop or terminate individuals depending on infractions.
  • Train team and answer questions.
  • Report to client.
  • Attend leadership meetings and implement improvement on topics of discussion.
  • Trained others on fraud awareness and prevention using additional steps in security measures.
  • Complete and Evaluate Performance of individuals on team.
  • Prepare Reports.
  • Budget and Track office departmental expenses.
  • Schedule and conduct weekly team meetings.
  • Respond to escalations when manager requested.
  • Motivate staff/team to achieve corporation’s metrics, goals, production and quality.
  • Maximize revenue/sales with upgrades or add on products to meet customer satisfaction.
  • Complete payroll and distribute checks to team.

Customer Support - Customer Service Rep

  • Speak with those in need of support by proactively listening to resolve issues.

Education

NHA VA license - Medical Billing and Coding

01.2022

Associate of Science -

Tidewater Community
Norfolk, VA
01.2015

Associate of Arts -

Tidewater Community
Norfolk, VA
01.2014

Skills

  • Management
  • Conflict resolution
  • Medicare-Medicaid expertise
  • Team collaboration
  • Healthcare industry
  • Appeals handling
  • Claims adjustment
  • Technical Support
  • Management- Admin-Call Center/Office

References

Available upon request

Keywords

  • REIMBURSEMENT ANALYST
  • CLAIMS PROCESSOR
  • CLAIMS
  • ADMIN
  • MANAGER
  • TECHNICAL SUPPORT
  • CUSTOMER SUPPORT
  • OFFICE
  • BENEFITS SPECIALIST
  • INSURANCE
  • MEDICARE SPECIALIST
  • LEAD
  • TRAINER
  • COORDINATOR OF BENEFITS PRICE COST

Timeline

Reimbursement Analyst - Claims Analyst

ANTHEM
01.2017 - Current

Technical Support

01.2009 - 12.2016

Healthcare/Admin - Claims - HR Benefits Specialist - Medicare Specialist

EDS
01.2002 - 05.2008

Office Manager

HAMPTON INN & CALL CENTER MCI
01.1996 - 12.2001

Customer Support - Customer Service Rep

NHA VA license - Medical Billing and Coding

Associate of Science -

Tidewater Community

Associate of Arts -

Tidewater Community

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