Tiffany Griffin

• Manages tickets within the ticketing system; troubleshoots and resolves tickets that are placed in the claims processing queues on time.

• Adjudicates information on multiple software platforms.

• Enforces procedures that are put in place by the Benefit Design Supervisor, Director of Claims Processing, and other Leadership.

• Identifies and corrects Benefit Design errors within the claims processor based on client documentation. This may include performing financial audits on the error(s) found and determining the impact for the client and/or Southern Scripts.

• Provides and potentially presents audit findings to Account Management and, on occasion, the Leadership team.

• Facilitates benefit designs for new clients within the claims processor based off of documentation.

• Communicate with the Implementation team to discuss and/or ask questions regarding benefit designs for new clients.

• Communicate with the EDI team to discuss and/or ask questions regarding various data files.

• Communicate with the Clinical team to discuss clinical edits that are active for current clients.

• Works in conjunction with the Clinical team to input information into the claims processor and makes updates based on extensive testing to ensure the clinical request is to appropriate specifications.

• Communicates with the Account Management team to facilitate benefit design updates and obtain appropriate documentation for current clients.

• Assists Customer Service Representatives with troubleshooting and resolving issues within the claims processor, when appropriate.

• Works in conjunction with an external programming team to analyze and resolve programming error(s) within our claims processor.

• Participates in developing additional quality assurance for internal processes.

• Complete research, follow-up, and external negotiations necessary with insurance companies to resolve member billing issues
• Report outcomes to senior leadership and provide next action steps for resolution
• Assist in claims negotiation settlements with providers and insurance companies through third party vendors
• Explain outcome to member along with guiding them through benefits selections for the upcoming year
• Provide feedback to members as it relates to future benefits choices
• Make calls and receive incoming calls to and from medical providers regarding claims issues
• Use web-based applications to research and resolved claims issues
• Demonstrates analytical and mathematical skills
• Paid extreme attention to detail and ability to prioritize activities to complete tasks
• Performed system analysis, documentation, testing, implementation and user support for platform transitions
• Coordinated statistical data analysis, design and information flow.
• Created various Excel documents to assist with pulling metrics data and presenting information to stakeholders for concise explanations of best placement for needed resources.
• Produced monthly reports using advanced Excel spreadsheet functions.
• Participated in requirements meetings and data mapping sessions to understand business needs.

• Operates within the scope of stakeholder's expectations to provide outstanding complete and accurate returns to customers
• Coordinate and manage high volume of end user chats on a continuous basis via the Tax Chat app
• Oversaw the Tax Chat email boxes while managing end-user expectations and communications
• Provide status updates in SharePoint and tax chat application
• Identify, document and communicate project scope and objectives
• Communicate project status updates, risks of incorrectly processed tax returns, and other opportunities present to senior project leaders
• Communicate costs through the tracking system, cost-benefit, and risk during the end stage of the project
• Act as the liaison and point of contact between the end user and the engagement team, managing internal databases designed to facilitate global team communications
• Monitors project status and provided updates as requested in reports to management
• Facilitated communication between internal and external project stakeholders to keep all parties well-informed.
• Prepared and charted data and metrics for detailed status reports.
• Recorded time allocated to projects and updated master tracking documents.
• Tracked project time and updated [Software] spreadsheets.

• Received information from providers for an update of information in the computer system(s) i.e., SharePoint, Quick Base,
• QNXT) within the scope of the request from stakeholders
• Communicated project status, risks, challenges, and success within the provider data Document Management System
• Loaded and maintained provider information into computer databases with attention to detail and accuracy in a timely manner to meet department standards of turnaround time and quality
• Monitored and reported project status during weekly meetings to management
• Audited loaded provider records for quality and financial accuracy and provides documented feedback
• Served as point of contact for the designated group and communicated with Senior Management about those groups
• Worked with project leaders with the purpose of integrating new/added applications to existing infrastructure
• Assisted in system related testing through automation of documents such as claims
• Coordinated statistical data analysis, design and information flow.
• Created various Excel documents to assist with pulling metrics data and presenting information to stakeholders for concise explanations of best placement for needed resources.