Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Timeline
Generic

Tiffany Ferrell

Atlanta,GA

Summary

10 plus years at Humana with compliance monitoring, auditing, and grievances and appeals. Skilled in data analysis, root cause reviews, Excel reporting, and regulatory compliance.

Overview

1
1
Certification
12
12
years of professional experience

Work History

Compliance Control Monitor (Medical, RX, & APLS)

Humana
Atlanta, Georgia
03.2022 - Current
  • Supports process improvements by error reporting and identifying process gaps.
  • Excel tracker creation including pivot tables and weekly task reports.
  • Auditing Grievance and appeals for compliance supporting timely resolution.
  • Identifies process errors and sends coaching opportunities.
  • Compliance case monitoring reviewing at minimum 60 cases daily.
  • Apply Medicaid guidelines in case reviews.

Compliance Control Monitor (Medical)

Humana
Atlanta, Georgia
08.2021 - 03.2022
  • Monitored medical compliance cases for CMS adherence.
  • Collaborated to resolve compliance issues.
  • Provided member outreach to reinforce CMS and quality standards.

Medical Intake Coordinator

Humana
Louisville, Kentucky
11.2015 - 08.2021
  • Researched and reviewed claims to identify processing issues, code edits, prior auth requirements, and reprocessing needs.
  • Handled inbound calls for prior authorization requests, code edits, and claims.
  • Collaborated with internal and external stakeholders to resolve issues accurately and timely.
  • Processed incoming faxes for prior authorization requests, code edits, and claims.

Intake Coordinator

Omnicare
Louisville, Kentucky
12.2014 - 11.2015
  • Reviewed patient applications and documentation to determine program eligibility, ensuring compliance with guidelines and improving access to resources.
  • Collaborated with healthcare providers, case managers, and pharmacies to streamline and improve patient intake processes.

Education

High School Diploma -

Eastern High School
Louisville, KY
05-1997

Skills

  • Grievance and Appeals knowledge
  • Compliance Monitoring
  • Medicaid case review
  • Root cause analysis
  • Process improvement
  • Excel reporting and analysis
  • Multitasking and prioritization

Certification

AAPC Certified Professional Coder, CPC 2026

Accomplishments

  • Multiple star award recipient
  • Maintains 98% accuracy rating

Timeline

Compliance Control Monitor (Medical, RX, & APLS)

Humana
03.2022 - Current

Compliance Control Monitor (Medical)

Humana
08.2021 - 03.2022

Medical Intake Coordinator

Humana
11.2015 - 08.2021

Intake Coordinator

Omnicare
12.2014 - 11.2015

High School Diploma -

Eastern High School
Tiffany Ferrell