Yolanda Mcqueen

*** ******** ****** #**

Brooklyn, NY 11223

Mobile: 718-***-**** E-mail:ac8c7s@r.postjobfree.com

EDUCATION

Bachelors of Science

John Jay College of Criminal Justice, New York, NY Major: Legal Studies

Date of Graduation: May 2002

EXPERIENCE

Provider Credentialing 02/2018-10/2018

EmblemHealth New York, NY

Verified Provider Credentials via Dentistat

Added Providers to Emblemhealth Fastrak System for accurate payments.

Added Providers to multiple locations within networks.

Updated Provider information for PAR and Non Par Providers. Senior Dental Claims Approver 02/2017- 10/2018

EmblemHealth New York, NY

Correcting dental claims as required for settlement.

Securing and/or confirming information necessary to approve, adjust and verify dental claims by telephone and/or correspondence

Evaluating inquires of dental subscribers and providers of service to determine correctness and accuracy of payment.

Making corrections regarding claims as necessary for settlement purposes.

Performing other related duties as assigned.

Knowledge of Fastrak operating systems.

Senior Medical Clerk 10/2011- 02/2017

EmblemHealth New York, NY

Composed Community Homecare And Durable Medical Equiptment DME cases for Case Managers review and approval along with Hospital and Community Home Infusion cases.

Confirming patient eligibility with insurance companies via fax, phone, and web.

Contacting insurance companies to inquire and dispute any open claims.

Provided Excellent Customer Service for Personal Care Services PCS, Private Duty Nursing PDN and Adult Day Health Care Services, Explained the process of each and sent out necessary forms for the services and reviewed forms for accuracy and completion.

Trained employees for coverage on homecare process and any new processes.

Responded to and answered telephone inquiries relating to authorizations for home care services and expedited cases as needed.

Investigated and intervened on behalf of EmblemHealth to resolve issues internally as well as externally between Agencies, Facilities, Physicians, Customer Service, Provider Relations, Medical Groups, and Members relating to homecare authorizations. Data Entry Specialist 02/2009-05/2011

GHI New York, NY

Accurately uploaded Member and Provider demographics to database to ensure timely payment of claims.

Confirmed Provider and Patient Relationships.

Yolanda Mcqueen

136 Saratoga Avenue #3A

Brooklyn, NY 11223

Mobile: 718-***-**** Email:ac8c7s@r.postjobfree.com

Medicare Coordination of Benefits CSR 05/2002-02/2009 GHI New York, NY

Assisted members with Initial Enrollment Questionaire’s on the phone and online.

Provided top notch customer service to all interested parties.

Determined primary payment status.

Data Entry Specialist (part-time) 08/2001-05/2002

GHI New York, NY

Accurately uploaded Member and Provider demographics to database to ensure timely payment of claims..

Confirmed Provider and Patient Relationships.

SKILLS

HIPPA Compliant trained

Proficient in Microsoft Word, Outlook, and Excel.

Ability to work in a fast pace environment and prioritize tasks accordingly.

Proficiency in Clinical Care Advance systems

Type 90 wpm

LEADERSHIP/VOLUNTEER WORK

FARR Community Garden

Girl Scouts of America- Parent Volunteer

*References available upon request*

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