Tiffany Harris
Allen,TX
Summary
Accomplished Senior Claims Reimbursement Specialist, offering 25+ years of experience, adept in streamlining claims processes and enhancing reimbursement efficiency through automation. Leveraged complex problem-solving and compassionate patient care skills, achieving significant improvements in claims accuracy and compliance. Mentored junior staff, fostering professional growth and team performance.
Overview
25
25
years of professional experience
1
1
Certification
Work History
In-Home Health Care Aide
Lala Healthcare
06.2019 - Current
- Assisted with daily living activities, promoting patient independence and overall wellbeing.
- Provided assistance in daily living activities by dressing, grooming, bathing, and toileting patients.
- Utilized problem-solving skills when faced with unexpected situations or emergencies within the healthcare setting.
- Kept accurate records of patients' care, condition, and progress.
- Collaborated with multidisciplinary team members to develop individualized care plans for patients.
- Administered medication as prescribed by healthcare professionals, ensuring adherence to schedules and dosages.
- Adapted quickly to changing patient conditions, adjusting care strategies accordingly for optimal results.
Senior Medical Claims Examiner
Sovereign Anesthesia
09.2019 - 01.2022
- Managed a high volume of complex cases, ensuring timely resolutions while maintaining attention to detail.
- Mitigated risk exposure by adhering to all policies and regulations governing the medical claims examination process.
- Stayed up-to-date on industry trends to inform decision-making processes and anticipate potential challenges.
- Mentored junior examiners, sharing expertise and guidance to improve overall team performance.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Served as a subject matter expert in company audits, providing insights into effective medical claims examination practices.
- Championed initiatives to incorporate digital tools into the claims examination process for improved efficiency.
- Maintained thorough knowledge of medical terminology and coding systems, contributing to precise evaluations of claim submissions.
Senior Claims Reimbursement Specialist
Pathologist Bio-Medical Laboratory
06.1999 - 10.2017
- Served as a mentor for junior team members, fostering their professional development through hands-on training opportunities and constructive feedback sessions.
- Increased claim reimbursement efficiency by streamlining the claims process and implementing automated systems.
- Collaborated with cross-functional teams to address complex claim issues, leading to efficient solutions that benefited both clients and the organization.
- Implemented quality assurance measures to ensure accuracy and consistency in claims processing, resulting in reduced errors and expedited reimbursements.
- Conducted regular audits on department processes, identifying areas for improvement and implementing changes as necessary to maintain optimal efficiency levels.
- Generated, posted and attached information to claim files.
- Posted payments to accounts and maintained records.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Provided expert guidance on claims policies and procedures during internal meetings, ensuring staff were knowledgeable about best practices within the field.
- Leveraged knowledge of industry regulations to ensure compliance in all aspects of claim processing and reimbursement practices.
Education
High School Diploma -
Seagoville High School
Dallas, TXBusiness Administration
Richland College
Dallas, TXSkills
- Complex Problem-Solving: Electronic submissions, claim edits, rejections, ERA, EOBs, Denials, Refunds, Collections, Online portals, scan charts
- Medicare, Medicaid, Commerical, Workers Compensation, Transplant
- Medical terminology: Revenue cycles, CCI, NCD/LCD, Modifiers, HCFA-1500, UB-140, ICD-9, ICD-10, HCPCS,
- Certified in CPR/AED
- Microsoft Office, Excel, Windows, Optum, Lytec, Epic
- Skip-tracer, unclaimed property, reconciliation aged accounts
- Companionship and emotional support
- Training and Mentoring Abilities
Certification
CPR certification
Volunteer
Habitat for Humanity
American Red Cross
Timeline
Senior Medical Claims Examiner
Sovereign Anesthesia
09.2019 - 01.2022
In-Home Health Care Aide
Lala Healthcare
06.2019 - Current
Senior Claims Reimbursement Specialist
Pathologist Bio-Medical Laboratory
06.1999 - 10.2017
High School Diploma -
Seagoville High School
Business Administration
Richland College
CPR certification
Similar Profiles
Rebekah PhillipsRebekah Phillips
Pediatric Home Health Nurse at LALA HealthcarePediatric Home Health Nurse at LALA Healthcare
Margaret MuriithiMargaret Muriithi
Licensed Vocational Nurse at Lala Healthcare Solutions LLCLicensed Vocational Nurse at Lala Healthcare Solutions LLC
JANE NDIRANGUJANE NDIRANGU
Licensed Vocational Nurse at Lala Healthcare Solutions, LLCLicensed Vocational Nurse at Lala Healthcare Solutions, LLC