Tiffany Kirkendoll
Houston,TX
Summary
Dynamic customer service leader with extensive experience at Cigna Insurance Companies, excelling in grievance resolution and case management. Proven expertise in benefits administration and strong organizational skills, driving process improvements and enhancing client satisfaction. Adept at mentoring teams and managing complex issues, ensuring compliance with industry standards.
Overview
11
11
years of professional experience
Work History
Grievance and CTM Customer Service Team Lead
Cigna Insurance Companies
Houston, US
11.2024 - 03.2025
- I coordinate and process Grievances, reach out to clients, follow a high workload and various duties assigned by Management
- Complete assigned caseload within designated timeframe, research complex issues and problem solve
- I also make outbound calls to members regarding the complaint, communicate with other departments when necessary to resolve member/provider issues
- The requirements include knowledge of formal and informal departmental goals, standards, policies and procedures, which includes familiarity of other departments within the organization that allows identification of workflow processes
- Handle other duties and special projects as assigned
Provider and Member Services Representative
Centene
Houston, US
05.2023 - 11.2024
- I assist members and providers with claim and authorization inquiries, benefits and updating demographics
- I completed various duties assigned by management
Provider and Member Customer Service Specialist
Meridian Healthcare
Houston, US
03.2023 - 05.2023
- I assist members and providers with every aspect of medical concerns
- I accurately assisted with benefits, enrollment, appeals, grievances, updating providers, reaching out to third party administrators and other assigned duties
- Handling escalated issues handled in an urgent manner
Health Program Representative I
Elevance Health
Houston, US
09.2022 - 03.2023
- I assist members by gathering and recording appropriate member information in accordance to policies and guidelines, direct members to appropriate staff, generate grievances and appeals and gather information from third party vendors and update member account
- I also contact providers and hospitals regarding claims and outstanding balances due by the member
- Assist Medicaid, Medicare and private plan members
Health Concierge
Aetna, a CVS Health Company
Houston, US
03.2021 - 10.2021
- I assist Associates with New Hire Enrollment, Life Events, updating personal information, handle escalated calls and served as an liaison
Client Service Specialist /Management Team
Positive Behavior Supports Corporation
Houston, US
01.2018 - 02.2021
- I provide intake and assistance to families in a confidential manner
- My job description was not limited to but including maintaining status of Credentialed Analysts, maintaining and reviewing Marketing, complete parent interviews, maintain database regarding client status, interview Analysts and providing client and Analyst mediation
- Verification of insurance, obtain diagnosis documents, research service needed from the client, complete intake interviews and other services as needed was equally important
- Always adapting to change and assisting Management team as needed
Liaison
Exact Billing Solutions
Houston, US
06.2017 - 05.2019
- I initiate and maintain the Credentialing process for individual and group providers
- In addition to organizing and maintaining documents I serve as liaison, contact hospitals and various agencies regarding Credentialing status
- I also maintain a working knowledge of the CMS database, PECOS, NEPPES, CMS, Leonardo Billing System, CAQH and other systems regarding credentialing
- My responsibility include other duties as assigned by Management
Provider Service/Credentialing Specialist
Family Care
Houston, US
04.2016 - 04.2017
- I worked with members and providers to obtain the appropriate eligibility, authorizations and complete the credentialing process
- I gathered information from members regarding eligibility and the medical/vision/dental service that is needed; along with providing clear and accurate guidelines regarding this process
- I contacted the provider regarding the status of their applications required
- I had the sole responsibility of retrieving OIG, NPDB, education verification, maintain spreadsheets
- Information is provided to the assigned Medical Director, set up credentialing meetings and maintain the appropriate reports
- I also trained new employees, audited the appropriate information and created written process include gathering paperwork from the provider, ensure all of the information is correct
- I retrieve education and review sanctions (if it applies), set up credentialing meetings, maintain organization skills, add providers to the primary database
- I completed other duties as assigned by management
Client Service Representative II/Credentialing
Getix-Patient Account Services
Houston, US
11.2015 - 02.2016
- My responsibilities included assisting patients with billing issues, hospital payment arrangements, setting up physician payment plans, assist with financial assistance and conclusion of accounts
- I utilized my excellent customer service skills, gained additional knowledge, training and assisted with new ideas and workflow function
- I credentialed providers, reviewed submitted material, retrieved State documents and other responsibilities as required
- Excellent Customer Service skills, continued growth and the ability to use useful job requirements
Customer Service Supervisor/Appeals and Grievance Auditor
Universal American
Houston, US
09.2014 - 12.2014
- Provide customer service, audit files for the Appeals and Grievance Coordinators, Review and Audit Medicare Appeals and Grievances, according to state guidelines and train representatives and coordinators as required
- Maintained strict adherence to State guidelines, follow Standard Operation Procedures (SOP) and mediate for the Customer Service Department and other areas
Education
BS - Business
University of Phoenix
Houston, TX12.2010
Personal Information
Authorized To Work: US for any employer
Timeline
Grievance and CTM Customer Service Team Lead
Cigna Insurance Companies
11.2024 - 03.2025
Provider and Member Services Representative
Centene
05.2023 - 11.2024
Provider and Member Customer Service Specialist
Meridian Healthcare
03.2023 - 05.2023
Health Program Representative I
Elevance Health
09.2022 - 03.2023
Health Concierge
Aetna, a CVS Health Company
03.2021 - 10.2021
Client Service Specialist /Management Team
Positive Behavior Supports Corporation
01.2018 - 02.2021
Liaison
Exact Billing Solutions
06.2017 - 05.2019
Provider Service/Credentialing Specialist
Family Care
04.2016 - 04.2017
Client Service Representative II/Credentialing
Getix-Patient Account Services
11.2015 - 02.2016
Customer Service Supervisor/Appeals and Grievance Auditor
Universal American
09.2014 - 12.2014
BS - Business
University of Phoenix
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