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Yolanda McDonaldYM
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Yolanda McDonald

@yolandamcdonald

I resolve complex healthcare claims, benefits, billing, and eligibility issues for members and providers.

Zimbabwe
Message

At Carelon (Beacon Health Options), I managed complex behavioral health claims disputes, conducted root-cause investigations for denied claims, and helped increase authorization processing efficiency by 30%.

Previously at Blue Cross Blue Shield of NC, I translated claims, copays, network coverage, enrollment, and eligibility processes into clear guidance for members. I resolve billing disputes with compassionate communication, maintain accurate CRM records, and support high-volume healthcare service operations.

Experience

Work history, roles, and key accomplishments

CO

Claims Analyst

Carelon (Beacon Health Options)

Apr 2019 - Oct 2024 (5 years 6 months)

Managed complex behavioral health claims disputes, increasing authorization processing efficiency by 30%. Conducted root-cause analysis investigations for denied claims and partnered with operational leaders to audit system logic and pricing edits.

BN

Customer Service Professional

Blue Cross Blue Shield of NC

May 2012 - Jun 2018 (6 years 1 month)

Delivered expert verification and benefit interpretation regarding claims, copays, and network coverage. Resolved complex billing disputes and assisted high volumes of clients with benefit enrollments and eligibility processes.

Education

Degrees, certifications, and relevant coursework

NC

New Horizons Computer Learning Center

Medical Billing, Coding & Office Information Management

Completed training in Medical Billing, Coding & Office Information Management.

RC

Richmond Community College

High School Diploma, General Studies

Earned a High School Diploma.

Tech stack

Software and tools used professionally

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