Tiffany Brown-Dotson
Farmers Branch
Summary
Adept at data entry and document control, I excelled at Healthsmart Preferred Care, processing up to 600 claims daily and significantly enhancing client satisfaction. My effective communication and teamwork ensured top performance, achieving the status of Top Customer Service Advocate for over half the year.
Overview
23
23
years of professional experience
Work History
Claims Router Support Specialist
Healthsmart Preferred Care
07.2016 - Current
- Process 200-600 facility and professional claims for tribal unit using QicLink.
- Route 100-200 facility and professional claims that require more processing for payment for tribal unit using QicLink.
- Reprice Dialysis claims using the Burgess and CMSP1 system
- Run CIL reports via QicLink.
Claims Repricer
Healthsmart Preferred Care
02.2014 - 07.2016
- Processed 300-600 facility and professional claims according to network contracted rates using ppoONE.
- Keyed claims data into system while interpreting coding and understanding medical terminology in relation to diagnoses and procedures using ppoONE.
- Monitored and followed up on pending claim activity timely and accurately.
- Prepared correspondence in a clear, concise manner.
- Adhered to all HIPAA rules and regulations.
- Met department standards for production and accuracy.
- Demonstrated working knowledge of provider data fields, including rate fields.
Customer Service Advocate
Healthsmart Preferred Care
02.2013 - 02.2014
- Answered 50-70 calls per day depending upon the volume in reference to claim and in network provider status, appeals and invoices.
- Demonstrated a sense of concern and empathy for customer’s situation.
- Met and maintained all quality and production requirements of the Advocate role.
- Diagnosed customer needs and provided appropriate first call resolution results.
- Communicated effectively and clearly with both internal and external customers in written and verbal form.
- Adhered to all company product and service guidelines, policies and procedures.
- Solved problems effectively with a logical approach.
- Possessed the ability to utilize the appropriate job related claims and benefit related operating systems.
- Performed all other duties assigned relative to Healthsmart's business or its business relationships.
- Adhered to all company policies, procedures and practices.
- Processed online claim status requests.
- Assisted providers with registering for online claim status.
- Assisted employees of groups\clients with navigating through the website to locate a provider in the Healthsmart network.
- Assisted the Client Services and Claims department with re-pricing claims.
- Top Customer Service Advocate Performer for 7 of the 12 months.
- Assisted patients in locating an in network doctor according to their plan via the Healthsmart website.
Eligibility Representative
CONEXIS
03.2002 - 11.2011
- Maintained client services and eligibility levels according to CONEXIS standards.
- Provided prompt, courteous service to all external and internal customers.
- Set up eligibility reports and file feeds for clients and carriers to communicate eligibility.
- Removed terminated clients from eligibility file feeds, eligibility reports and inactivated all communication.
- Case distribution and processing.
- Processed Qualifying Events for COBRA members and Group Contact Profiles.
- Answered eligibility and plan related phone calls from external and internal customers.
- Set up web access for clients.
- Keyed insurance carrier rates.
- Reported eligibility to carriers for COBRA insurance members who did not show active with their carrier after premium payment was made.
- Entered client contact information into the database.
- Monitored Eligibility phone line and taking calls related to eligibility, rates, plan information, resetting web access passwords and explained client ‘s premium statements.
- Processed Notice Hold, Cancellation and Election Notice Error reports.
- Conducted peer audits on the new business entered into the system to assure accuracy.
- Eligibility Subject Matter Expert for the Staff.
- Explained Premium Payment Registries to clients.
- Worked closely with Anthem, BCBS, Aetna, Guardian, Eyemed, Delta Dental, Medco and Caremark.
- Provided clients with all the information needed in reference to eligibility in order to avoid call-ins from the client.
- Assisted clients with navigating through the company website.
- Developed professional relationships with carriers and clients who were comfortable with contacting me for anything related to their account.
- Conducted mail audits to assure Election Notices, Invoices, and Insufficient Funds notices were accurate.
Education
High School Diploma -
Bastrop High School
05.1991
Skills
- Error identification
- Verifying data accuracy
- Meticulous attention to detail
- Multitasking and organization
- Data entry
Timeline
Claims Router Support Specialist
Healthsmart Preferred Care
07.2016 - Current
Claims Repricer
Healthsmart Preferred Care
02.2014 - 07.2016
Customer Service Advocate
Healthsmart Preferred Care
02.2013 - 02.2014
Eligibility Representative
CONEXIS
03.2002 - 11.2011
High School Diploma -
Bastrop High School
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