Yvonne Richardson

Email: vonneemarie****@ gmail.com

Fontana, CA 92335

Summary

Professional Provider/Enrollment Specialist and Member Services Representative who has worked with clients like BoulderCare, Employment Development Department, TeleCare Corporation and CVS Pharmacy.

Supported potential and current patients seeking substance use disorder (SUD) care by answering questions about our services in regards to pharmacy medications, benefit enrollment and administration & HEDIS projects.

Answered Inbound/Outbound calls up to 100 calls a day.

Answered chat and phone calls from current patients – scheduling visits, collecting payment as needed, troubleshooting technical issues, and escalating and routing concerns as needed.

Thorough knowledge, understanding & experience in the processing of Medicare Part A, B, C & D, customer grievances, PA’s, IPA’s, FEPs, HEDIS projects, Insurance Verification/Financial Clearance, HIPPA. & Staff Scheduling, for the Unit.

Proficient in working with Microsoft Word/Suite, Access, Excel (Formulas), Microsoft Teams, Slack, Zoom, Outlook, IDX, Dynamo, QXNT, MediSoft, Sales Force, 10-key, & PowerPoint, Ninox, Kintone, & Genesys Phone System.

internet connection through AT&T and she is ready to join immedieatly, if offered.

Professional Experience

Gap Reason: Looking for the job opportunities.

BoulderCare, Remote position-Portland, OR

November 2022 – June 2023

Provider/Enrollment Specialist

Supported potential and current patients seeking substance use disorder (SUD) care by answering questions about our services in regards to benefits, pharmacy medications, enrollment and administration, & HEDIS projects, checking eligibility and benefits, creating patient charts, processing of Medicare Parts ABC&D, customer grievances, PAs, FEP’s scheduling initial visits, and making every caller feel welcome and supported.

Answered chat and phone calls from current patients – scheduling visits, collecting payment as needed, troubleshooting technical issues, and escalating and routing concerns as needed.

Served as a central communication hub for Boulder’s Care Team, providing administrative and scheduling support. Increase team efficiency by creatively managing schedules and filling gaps.

Monitoring incoming faxes, adding files to patient charts, and communicating critical information to the team.

Navigate different insurances by communicating benefits & coverage to patients.

Employment Development Department-Remote Position

April 2022 – October 2022

Fact Finder Agent- (Remote position- CA, Alabama, & Virginia)

Assessed the information against requirements based on UI Code, Policies, HEDIS projects & Procedures, while using critical thinking& work instructions to determine the method of resolution for pending issues, resolve issues or request additional information as applicable.

Worked closely with subject matter experts to gain further understanding of how to address outstanding issues or identify when a claim needs to be escalated, Benefit Audit Agents will also perform job duties such as: analyzing claim information to identify discrepancies missing information, sending employers standard forms to obtain additional information or clear up a discrepancy, reviewing/resolve complex issues referred by other front line staff, reviewing wage/income information, benefits payments, and cross-matching to determine if payments were made appropriately

Notation of all actions taken on a claim clearly & thoroughly, demonstrating the ability to manage a workload in a way that meets timeliness requirements & all other additional duties as assigned by management to support claim processing.

CVS Pharmacy/Aetna – San Diego, CA- (Remote Position -Temporary)

June 2021 – June 2022

Member Services Representative

Responsibilities include extensive knowledge of Medicare Part D, grievances, member contact via telephone, handling inbound/outbound calls pertaining to processing of orders, of Medicare Parts ABC&D, customer grievances, PA’s, HEDIS, change of PCP, pharmacy medications, explanation of coverage of member health plans.

Ability to research & investigate orders using Peoplesoft and LINKS.

Notifying members of decisions, changes, or other relevant information pertaining to request/inquiry of health insurance plans.

Handling payment/pharmacy issues & making appointments for our members.

Perform required transactions to complete mail order prescriptions.

Follow through on standard operating procedures, problem-solving and troubleshooting within guidelines.

Ability to work under strict turn-around-times.

TeleCare Corporation - Merrill CSU Fontana, CA - On Call Position

July 2020 – June 2023

Patient Support/Unit Secretary/Peer Counselor

First Point of contact for the Behavioural Health Unit, processed Medicare Parts ABC&D, customer grievances, PA’s, Admits, Transfers & Discharges (Home, SNF, Board & Care or other facilities) of patients.

Extensive use of ADT, PRIME, HEDIS, EPIC, AVATAR, EMR, GRASP, Health Connect, & PARRS.

Additional duties include auditing of all EMRs to ensure accuracy & signatures, coordination of all Staffing needs of the unit, transcribing physician orders, scheduling F/U physician appts, taking STAT lab orders to lab with no delays. Familiarity with pharmacy medications.

Heavy Incoming and outgoing call handling on daily basis working as Liaison between families, PCC, other departments, Nurse, Physicians & units etc., & phones/filing.

LeDay HomeCare, LA/San Diego-

Jan 2010 – July 2020

Medical Office Manager/Unit Secretary

Managed daily operations of the Home Health office.

Primary point of contact for personnel and administrative issues for 25 staff members.

Worked daily with sensitive & confidential medical information ensuring HIPPA compliance.

In addition, other duties included auditing of all HEDIS projects, EMR’ for accuracy/signatures, coordination of staff scheduling, took payments for services rendered, answering of multi-phone lines, retrieve appropriate paperwork from patients, obtain documentation from physicians, Insurance verification, processing of Grievances. PA’s from insurance company, transcribing Physician orders, audit charts, data entry, talking with patients and scheduling F/U appts, coordination of all Staff scheduling for the unit, order supplies for employees/office & working with clinical staff to ensure excellent patient care.

Thorough of knowledge & understanding of Medicare Parts ABC&D/Medicaid certification/accreditation.

Education And Certification

Diploma, Susan Miller Dorsey HS-Los Angeles, CA Jan 1979

High school diploma

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