Piffiany Sanders
Rochester,NY
Summary
Experienced professional with a strong background in healthcare support, client services, and program evaluation. Demonstrated expertise in eligibility determination, insurance verification, claims processing, and empathetic communication. Also experienced in patient care and medical documentation. Obtained CNA certification in 2007 and worked in nursing home settings Seeking a role that prioritizes one-on-one support and meaningful interactions.
Overview
7
7
years of professional experience
Work History
Provider Services Representative
MVP Health Care
Rochester, NY
08.2024 - 03.2025
- Manage high-volume inbound calls, providing detailed information on patient benefits, eligibility, deductibles, out-of-pocket amounts, and prior authorizations
- Resolve provider inquiries related to CPT codes, network status, and claim reviews, ensuring accuracy and efficiency
- Conduct claims analysis, clarifying denial codes and payment amounts for providers
- Adhere to health plan policies while maintaining excellent customer service in a fast-paced, monitored environment
Energy Program Evaluator (Provisional)
Monroe County
Rochester, NY
12.2021 - 07.2024
- Processed HEAP applications, determining eligibility through detailed income and documentation verification
- Conducted emergency intakes for clients at risk of utility disconnection, providing timely assistance and submitting payment agreements
- Verified client information using tools like Monroe County property search to ensure compliance with program guidelines
- Accurately calculated eligibility and benefit levels using the T-MAG system, maintaining thorough records and client communications
CDPAP
Elite Staffing Inc.
Rochester, NY
08.2020 - 12.2021
- Provided in-home care for my mother during her lung cancer treatment, ensuring her comfort and well-being
- Managed daily medication reminders, appointments, and dietary needs, while coordinating with healthcare providers
- Delivered compassionate support to maintain her emotional and physical dignity during treatment
Patient Service Representative
Rochester Eye Associates
Rochester, NY
10.2017 - 04.2021
- Manage high-volume inbound calls, providing detailed information on patient benefits, eligibility, deductibles, out-of-pocket amounts, and prior authorizations
- Resolve provider inquiries related to CPT codes, network status, and claim reviews, ensuring accuracy and efficiency
- Conduct claims analysis, clarifying denial codes and payment amounts for providers
- Adhere to health plan policies while maintaining excellent customer service in a fast-paced, monitored environment
Education
Diploma - General Education
Iroquois Job Corps
Medina, NY10.2007
Certified Nursing Assistant -
Iroquois JobCorps
Medina NY 2007
Skills
- HIPAA Compliance & EHR Management
- High-Volume Call Management
- Blood Pressure Monitoring
- Medication Organization & Assistance
- Medical scheduling
- Documentation & Data Entry Accuracy
- Insurance Verification & Claims Processing
- Program Eligibility Determination
- Customer Service & Empathy
Additional Information
Served as a CDPAP caregiver
until 2021, assisting with low blood pressure monitoring, medication organization, and personal care. previous used in EMR systems (Medent, NextGen, Energy Systems) and medical office operations.
as a CDPAP caregiver until 2021, assisting with low blood pressure monitoring, medication organization, and personal care. Proficient in EMR systems (Medent, NextGen, Energy Systems) and medical office operations.
Timeline
Provider Services Representative
MVP Health Care
08.2024 - 03.2025
Energy Program Evaluator (Provisional)
Monroe County
12.2021 - 07.2024
CDPAP
Elite Staffing Inc.
08.2020 - 12.2021
Patient Service Representative
Rochester Eye Associates
10.2017 - 04.2021
Diploma - General Education
Iroquois Job Corps
Certified Nursing Assistant -
Iroquois JobCorps