Summary
Overview
Work History
Education
Skills
Locations
Timeline
Generic

Tiffany E. Moore

Summary

Medicaid representative with experience in managed care, compliance, grievance and case management. Looking to expand my knowledge and join a forward moving team.

Overview

9
9
years of professional experience

Work History

Territory Manager

Medicaid Done Right
09.2024 - Current
  • Managed 8 homes and their Medicaid population
  • Cultivated client relationships to enhance satisfaction with Medicaid services.
  • Assisted families completing long term care applications
  • Collected necessary documents that were often unavailable to the facility
  • Traveled throughout community to gather necessary documents for residents.
  • Connected with families in community to address needs of those unable to meet at facility.

Senior Appeal Analyst

Aetna Better Health of Illinois
01.2020 - Current
  • Resolved member issues reported to health plan from Bureau of Managed Care
  • Process Executive and Escalated Complaints
  • Process Department of Insurance complaints
  • Process Social Media Complaints
  • Process Provider Retro Authorization Request
  • Investigated interdepartmental records to address and resolve issues
  • Coordinated with management to address state escalated requests
  • Facilitated state fair hearings to address member grievances.
  • Tracked and reported trends quarterly and annually to inform strategic decisions
  • Maintain compliance expectations
  • Lead for G&A special projects

Compliance Coordinator

Illinicare /Ambetter Health
01.2017 - 01.2020
  • Processed complaints from the OIG (Office of the Inspector General)
  • Processed Attorney General Complaints
  • Processed Department of Insurance Complaints
  • Developed and maintained tracking system for trending records to enhance compliance oversight
  • Conducted quarterly HIPAA workstation audits to ensure regulatory adherence
  • Assisted SIU research efforts by gathering and analyzing information on requests and incidents to inform decision-making

Education

Alabama A&M University
Huntsville, AL

High school -

Hillcrest High School
Country Club Hills, IL

Skills

  • Customer Relationship Management
  • Regulatory Compliance
  • Case Management
  • Data analysis
  • Proficient in Microsoft Office
  • Problem Solving
  • Critical Thinker
  • Adaptability
  • Interpersonal Skills
  • Appeal and Complaint Handling
  • IL Notary

Locations

  • Alabama A&M University, Huntsville, AL
  • Hillcrest High School, Country Club Hills, IL

Timeline

Territory Manager

Medicaid Done Right
09.2024 - Current

Senior Appeal Analyst

Aetna Better Health of Illinois
01.2020 - Current

Compliance Coordinator

Illinicare /Ambetter Health
01.2017 - 01.2020

Alabama A&M University

High school -

Hillcrest High School
Tiffany E. Moore