TIFFANY MCBRIDE
Orange,USA
Summary
Experienced Medical Claims Processor with a proven track record in building strong provider relationships and resolving claim status and denials. Highly motivated and efficient in handling multiple administrative tasks. Recognized for exceptional investigative skills in claims processing.
Overview
7
7
years of professional experience
Work History
Fraud Specialist/Customer Service
Fiserv
01.2023 - Current
- Assist members with enrolling in online banking through mobile app or website.
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Organized professional with expertise in managing resources and optimizing performance. Proficient in providing valuable insights and supporting decision-making processes. Committed to enhancing productivity and contributing to overall success.
- Managed approximately 100 incoming calls per day from customers.
Medical Claims Processor
Mindlance
01.2021 - 11.2023
- Maintained accurate records and full compliance with government regulations and agency guidelines.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Reviewed provider coding information to report services and verify correctness.
- Managed approximately 30-60 incoming calls, emails and faxes per day from customers.
Prior Authorization Representative
CVS
01.2018 - 12.2021
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Assisted pharmacies in prior authorization claims processing by giving information needed to process the claim such as prior auth number, medication information, etc
- Tracked referral submission during facilitation of prior authorization issuance.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Manage approximately 50-60 incoming calls, per day from customers.
Education
High School Diploma -
Franks Educational
Beaumont, TX05.2010
Skills
- Appointment Scheduling
- Proficient in CRM Systems
- Medical Terminology
- Electronic claims processing
- Insurance verification
- Proficient in 10-Key
- Problem Solving Abilities
- HIPAA
- Knowledgeable in (Microsoft Suite/Excel)
Timeline
Fraud Specialist/Customer Service
Fiserv
01.2023 - Current
Medical Claims Processor
Mindlance
01.2021 - 11.2023
Prior Authorization Representative
CVS
01.2018 - 12.2021
High School Diploma -
Franks Educational
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