Tiffany Gibson

Utilizes proactive triggers for diagnoses, cost criteria, and complications to identify potential appropriate utilization of services and initiate appropriate referrals to physician advisor in a timely manner.

•Understands proper utilization of health care resources and assists with identifying barriers to patient progress and collaborates with the interdisciplinary team.

•Conducts medical necessity review of all admissions. While utilizing approved clinical review criteria to determine medical necessity for admissions including appropriate patient status and continued stay reviews as necessary.

• Provide necessary notification and supporting clinical documentation to commercial and governmental insurance carriers within a timely manner and arrange peer to peer review with internal physicians advisor to assist with denials and promote cycle revenue.

• Responded to patient emergencies to provide prompt and correct intervention .
• Collaborated with multidisciplinary team to evaluate patient data and determine patient care plans.
• Participated in quality improvement initiatives to improve patient care outcomes.
• Educated patients and families to increase understanding of condition and best ways to manage.