Tiffany Jones
Phoenix,AZ
Summary
Focused Leader with over 20 years of experience in Healthcare with expertise in Pharmacy, Auditing, Vendor Management, and Pharmacy Benefit Management. Knowledgeable and a problem-solver with a strong record of accomplishment in meeting and exceeding productivity targets and organizational goals.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Contact Center Supervisor
MedImpact Healthcare Systems Inc.
10.2023 - Current
- Enhanced customer satisfaction by efficiently resolving escalated issues and providing exceptional support.
- Streamlined contact center operations for increased efficiency and improved service quality.
- Contributed to teaching points for training programs to enhance team performance and productivity for both current and future employees.
- Reduced average handling time with effective coaching and feedback sessions for agents.
- Conducted regular performance evaluations, identifying areas of improvement and implementing corrective action plans for underperforming agents.
- Created a positive work environment, fostering strong teamwork and agent engagement.
- Monitored contact center metrics to identify trends, implement process improvements, and drive continuous improvement initiatives.
- Developed strong relationships with other department leaders to promote collaboration towards shared company goals.
- Championed employee recognition programs, boosting morale and increasing overall job satisfaction within the contact center team.
- Demonstrated professional and polished demeanor with positive, upbeat and friendly personality and supported calling work during times of peak contact volume.
- Supervised and tracked phone and email activity using various contact center applications and software tools.
- Monitored call quality and provided individual constructive feedback to enhance performance and address areas in need of improvement.
- Prepared agendas and took notes at meetings to archive proceedings.
- Facilitated regular team meetings to discuss challenges, successes and strategies.
Manager, Patient Safety and Clinical Quality
Amazon Pharmacy
10.2020 - 03.2023
- Oversee and manage a team of up to 20 pharmacy technicians and specialists
- Understand technologies involved in a project(s) at a high level, enough to constructively participate in and contribute to solution discussions in your team
- Manage project communications and may serve as the first point of contact for team projects and escalations
- Identify the best practices/methodologies to mitigate the risk issues you manage, to improve risk-related processes, and to help resolve blocking problems
- Ownership over small risk projects
- Act as representation for department in super groups
- Create/set-up dashboards for metric tracking and departmental projections
- Support the Patient Safety Operations Manager with projects and strategies tied to quality initiatives
- Ensure success metrics are established and in place for all risk projects
- Participate in the interview process and help train new members of the team when needed
- Assist in the establishment of metrics and department goals
- Collaborate with HR and department leadership to coach and counsel staff members accordingly for performance, quality, attendance and conduct concerns when appropriate
- Responsible for the execution, and delivery of straightforward risk projects and activities related to an existing program for a defined risk strategy
- Assign individual responsibilities to others supporting risk area/impacted by your project
- Develop appropriate milestones and launch project schedules to ensure timely and successful delivery of a project and standard work
- Know the risk thresholds for area of responsibility, how to test for them, and know the actions to take when thresholds are exceeded
- Other duties as assigned.
Sr. Disability Representative
Sedgwick Claims Management
09.2018 - 07.2020
- Analyze, approve, and authorize assigned claims and determines benefits due including FMLA
- Review complex medical documentation to determine disability as defined by plan
- Consistently communicate with providers to set expectations for return to work
- Manage disability claims ensuring compliance via phone, email and postal mail
- Resolve issues on claims such as patient data and provider info
- Coordinate investigative efforts ensuring appropriateness while providing a thorough review
- Maintain client and provider relationships
- Update benefit plans as provided by Client
- Continuous follow up with claimants until released to work.
Business Unit Compliance Liaison
Blue Cross Blue Shield of MI
04.2012 - 11.2017
- Collect and document Pharmacy Services and vendor performance requirements (monthly, quarterly)
- Analyze data and other quarterly/contractual reports received from the Pharmacy Benefits Manager to ensure accuracy and compliance as it relates to the service level agreement
- Oversee and maintain issue and project tracking log and related repository
- Coordinate/attend all departmental meetings related to projects, audits, and contractual reviews
- Work closely with subject matter experts to resolve concerns with the Pharmacy Benefits Manager and to prepare for internal and external audits
- Manage audits for Pharmacy Services and collaborate with other areas on internal and external audits
- Design effective Pharmacy Services and vendor performance monitors
- Collect required documentation as required by NCQA and HEDIS
- Create reports and communications to improve department performance
- Act as a liaison for annual internal audits such as MAR and SOC 1/SSAE16
- Train new staff as necessary
- Provide support to areas of Pharmacy Services needing Compliance assistance
- Act as Compliance Liaison (communicate Compliance related updates to business area, ensure adherence, coordinate any necessary training, and identify and report and Compliance concerns via Metric Stream)
- Archive all departmental documents (shared drives, SharePoint etc) for future reference
- Other duties as assigned.
Member Compliance Department Manager
Meridian Health Plan
08.2011 - 02.2012
- Manage, train, audit and assign cases for management to staff of 5+ employees
- Train and educate internal staff and new hires on compliance procedures and functions
- Assist in resolutions of member complaints and grievances
- Develop and improve departmental workflow, policy and procedures, including product lines in other states
- Coordinate with internal departments i.e., Compliance Officer, Pharmacy, Provider Services, Care Management
- Implement new and inventive ways to meet and increase production standards, departmental and companywide goals
- Maintain external relationships with State officials, physician’s offices, hospital staff, etc
- Investigate fraud, waste, and abuse as well as drug diversion
- Sign off on all proposals submitted to MDCH
- Other management and administrative duties i.e., payroll, scheduling, performance improvement.
Member Compliance Specialist
Meridian Health Plan
11.2008 - 08.2011
- Tracking/trending non-compliant members, creating corrective action plans to modify behaviors
- Member outreach via phone and mail, providing education and resources to members that meet compliance criteria
- Assist member with receiving adequate care needed, which includes scheduling and assisting with transportation/appointments
- Compile and review chart notes and medical records of adverse behaviors displayed
- Interact with outside providers to assist with plans for the member while collaborating with other internal departments in regard to the member
- Provide direction and guidance for the team/staff while working closely with the management staff
- Manage/train/counsel current and new staff
- Responsible for updating policies and procedures for the department.
Pharmacy Technician
Meridian Health Plan
03.2008 - 11.2008
- Duties consist of acting as a pharmacy liaison between pharmacy benefits manager and health plan, assisting physicians with prior authorizations and any pharmacy concerns
- Compile, analyze, and manage the data needs for pharmacy operation
- Oversee narcotic lock program for members and internal departments
- Assist physicians with obtaining clinically appropriate medications via prior authorization process
- Prepare monthly and quarterly pharmacy related reports for department, internal and for the Pharmacy Therapeutics Committee
- Provide support to clinical and non-clinical departments to determine needs, resolve problems, improve processes, and promote effective drug therapy.
Lead Pharmacy Technician
CVS Pharmacy
12.2003 - 03.2008
- Assist pharmacist with daily pharmacy tasks
- Review inventory and handle accordingly
- Create schedule for staff utilizing budgeted hours
- Train new staff as necessary
- Resolve pharmacy customer issues or escalate as necessary
- Organize staff meetings
- Update staff with company/industry news to create a more effective work environment
- Maintain daily/weekly shipments/orders
- Other duties as assigned.
Education
AA - Healthcare Administration
University of Phoenix
10.2014
Skills
- Remote Leadership Experience
- Project Management
- Performance Monitoring
- Communication
- Employee training and development
- Vendor Management
- Auditing
- Meeting Facilitation/Presentation
- Data analysis
- Google and Microsoft Office
- Slack
- Salesforce
Certification
- Pharmacy Technician Certification Board, PTCB Certification, 06/2007
- Arizona Board of Pharmacy, State License, 10/2020
Timeline
Contact Center Supervisor
MedImpact Healthcare Systems Inc.
10.2023 - Current
Manager, Patient Safety and Clinical Quality
Amazon Pharmacy
10.2020 - 03.2023
Sr. Disability Representative
Sedgwick Claims Management
09.2018 - 07.2020
Business Unit Compliance Liaison
Blue Cross Blue Shield of MI
04.2012 - 11.2017
Member Compliance Department Manager
Meridian Health Plan
08.2011 - 02.2012
Member Compliance Specialist
Meridian Health Plan
11.2008 - 08.2011
Pharmacy Technician
Meridian Health Plan
03.2008 - 11.2008
Lead Pharmacy Technician
CVS Pharmacy
12.2003 - 03.2008
AA - Healthcare Administration
University of Phoenix
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