Yvonne Starke
Chesterfield,VA
Summary
Responsible Team Coordinator with passion for managing complex responsibilities with organized and resourceful approach. Intelligent and analytical with excellent communication and collaboration skills. . Strong research, data entry and contract preparation abilities.
Overview
17
17
years of professional experience
Work History
team coordinator
optima health plan
12.2021 - 09.2023
- Facilitated meetings, coordinated agendas, reviewed, and approved time.
- Maintained planning foresight and managed business calendar.
- Developed and supported staff to assist with various duties.
- Maintained records and provided training.
- Monitored team performance and led improvement efforts in customer service, quality, and financial accuracy.
- Fostered strong, collaborative relationships with members, providers, and internal partners.
- Identified opportunities for process improvement.
Claims processor
virginia premier
12.2013 - 12.2021
- Accurately and timely data entry and validation of claim images
- Prepared spreadsheets and reports for daily workload
- Uploaded corrected claims while maintaining edits in EDI data system.
- Corrected edits for claims to adjudicate.
- Interacted with clients and navigated multiple computer applications.
- Reviewed and proofread claims to determine appropriate action based on guidelines.
Provider Service Rep-Team LEAD
Kepro
07.2006 - 12.2013
- Researched plan documents to determine benefit administrative denial appropriateness
- Worked cross-functionally to address provider service issues and process improvement
- Assisted members and providers in filing formal appeals and grievances
- Processed incoming mail for Appeals Department
- Managed prior authorization for EDCD Waiver Services and Long-Term Care
- Assisted providers with using medical services and web portals.
Education
Some College (No Degree) -
Bryant And Stratton College
ChesterfieldDIPLOMA -
John F Kennedy High School
Richmond06.1994
Skills
- Knowledge of Medicaid and Medicare Policy and Procedures
- Independent judgement and decision making
- Knowledge of QXNT, Macess, IDX, EDI systems
- Comfortable with majority office equipment
- Analytical thinker
- Great communication abilities with medical groups
- Quality improvement competency
- Tracking Metrics
- Thorough Understanding of Business
- Account Management
- Team Relationships
Activities
- Subject Matter Expert Train the Trainer Course
- Lean Six Sigma – Yellow Belt
- Training Lead Program
Timeline
team coordinator
optima health plan
12.2021 - 09.2023
Claims processor
virginia premier
12.2013 - 12.2021
Provider Service Rep-Team LEAD
Kepro
07.2006 - 12.2013
Some College (No Degree) -
Bryant And Stratton College
DIPLOMA -
John F Kennedy High School
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