Tiffany McCadney
Hurst,TX
Summary
Insightful Manager with experience directing and improving operations through effective employee motivational strategies and strong policy enforcement. Proficient in best practices, market trends and regulatory requirements of industry operations. Talented leader with analytical approach to business planning and day-to-day problem-solving.
Overview
12
12
years of professional experience
Work History
Client Sucess Manager Prior Authorizations
OncoSpark
Southlake, Texas
01.2024 - Current
- Responsible for leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard
- Developed strategies to increase team productivity and improve customer service levels
- Conducted performance appraisals for team members, providing feedback and identifying areas of improvement
- Trained new staff in relevant processes and procedures
- Resolved escalated customer complaints or queries promptly and efficiently
- Monitored team performance against targets, taking corrective action where necessary
- Supported the manager in developing plans for future projects, initiatives and objectives
- Implemented performance, quality and efficiency measures to achieve aggressive production goals
- Identified needs of customers promptly and efficiently
- Identified areas for improvement, narrowing focus for decision-makers in making necessary changes
- Organized client meetings to provide project updates.
Prior Authorization Specialist
Medix Infusion
Addison, TX
02.2023 - 12.2023
- Responsible for verifying insurance eligibility and benefits for infusion services
- Reviews payer medical necessity guidelines and ensures proper documentation is on file to support therapy
- Submit and follow-up timely with authorization, predetermination, and appeal requests
- Work closely with the Intake, Scheduling, Pharmacy, and Clinical departments in managing patient care while promoting compassionate high-quality standards
- Verify insurance with all payer types, including Medicare, Medicaid, and commercial insurance companies
- Verifies insurance eligibility and benefits via phone, fax, or payer portals
- Provides timely completion of insurance review for established patients
- Documents timely and accurately in the EMR system
- Reviews payer medical policies to determine medical necessity and/or FDA guidelines including Medicare billing and coding guidelines
- Coordinates with medical providers in obtaining necessary documentation to support medical necessity
- Submits appeal request to payers for denied authorizations and follows-up on timely turnaround
- Obtains authorization for infusion services for established patients
- Knowledge of reimbursement policies.
Patient Access Specialist
McKesson
Fort Worth, TX
12.2022 - 02.2023
- Patient Access Specialist responsible for maintaining effective communication between patients, financial assistance programs, practice organizations, and other departments as needed
- Maintain excellent written and verbal communication
- Submit prior authorizations via payer portals, phone or fax
- Documented all prior authorization information in patient profiles, including approval dates and prior authorization numbers
- Processed referrals and submitted clinical supporting documentation to insurance carriers to expedite prior authorization processes
- Researched and securing available financial assistance programs to assist patients in reducing infusion therapy costs
- Work closely with patients to ensure understanding of medical insurance benefits, collecting patient financial responsibility and provide financial counseling as needed.
Benefit Coordinator/Prior Authorization Specialist
US BioServices Specialty Pharmacy/CVS
Carrollton, TX
08.2019 - 10.2022
- Performed clerical functions for patient billing, including verification of insurance information and resolution of problems to ensure a clean billing process
- Followed up on accounts that require prior authorization and appealed for medication coverage
- Contacted insurance carriers to verify patient’s insurance eligibility, benefits, and requirements
- Secured patients' demographics and medical information using discretion to protect privacy
- Prioritized prior authorizations in alignment with expiration deadlines
- Documented all prior authorization information in patient profiles, including approval dates and prior authorization numbers
- Processed referrals and submitted clinical supporting documentation to insurance carriers to expedite prior authorization processes
- Reviewed denials and submitted appeals to gain approval from insurance companies
- Processed referrals and submitted medical records to insurance carriers to expedite prior authorization processes
- Reviewed accuracy and completeness of information requested and verified presence of all supporting documentation
- Managed correspondence with insurance companies, physicians and patients as required
- Analyzed denials and submitted appeals to obtain approval from insurance companies
- Informed individuals about the eligibility requirements, application processes and payment procedures for the benefits program.
Customer Service Specialist
Teladoc
Lewisville, TX
10.2018 - 08.2019
- Receiving inbound calls from Teladoc customers
- Helped connect patients with doctors, assisted with patient registrations, verified memberships, set appointments, helped manage billing, and troubleshoot basic technical issues
- Reviewed customer history as necessary to ensure… Followed policy and procedure guidelines
- Registered patients
- Verified memberships
- Added customer to the appointment queue
- Helped answer billing questions and resolve billing issues
- Helped with basic technical issues
- Documented information and outcomes as necessary.
Insurance Verification Specialist
DaVita Rx
Coppell, TX
02.2013 - 10.2018
- Insurance verification and adjudication rejections related to patient prescriptions are processed accurately, efficiently, and timely in complete accordance with all applicable laws, regulations, and company policies
- Verified health insurance information to check enrollment, eligibility, and insurance data integrity
- Explained fees and patient financial responsibility, and informed patients of existing balance due
- Reviewed patient charts for completeness, verifying missing information to improve data quality
- Investigated and resolved complaints and appeals relating to errors in claim processing for completed services
- Outbound telephone calls to physicians, patients, and insurance providers
- Obtained insurance pre-authorization for patients and reauthorization of medication and additional treatment to fulfill prescription requests
- Collaborated with patients, pharmacy staff and other health care professionals to support and enhance patient-centered care.
Education
Insurance Billing and Coding Specialist Diploma -
Concorde Career Institute
Arlington, TXDiploma -
West Jefferson Senior High School
Harvey, LASkills
- Effective Communication
- Customer Service
- Medical and Specialty Pharmacy Insurance Knowledge
- Conflict Resolution
- Administration
- Proficient in Microsoft Office Suite
- Prior Authorization
- Denials & Appeals
- HIPAA Compliance
- Client management
- Knowledge with all payers Commercial, Medicare and Medicaid
- Team Leadership
- Time Management
- Verbal and written communication
- Complex Problem-Solving
- Staff Training and Development
- Project Management
- Cross-Functional Teamwork
- Staff Development
- Policy Implementation
- Computer Skills
- Problem Resolution
- Multitasking
- Attention to Detail
- Hiring and Training
- MS Office
- Process Improvement
- Project Planning
Timeline
Client Sucess Manager Prior Authorizations
OncoSpark
01.2024 - Current
Prior Authorization Specialist
Medix Infusion
02.2023 - 12.2023
Patient Access Specialist
McKesson
12.2022 - 02.2023
Benefit Coordinator/Prior Authorization Specialist
US BioServices Specialty Pharmacy/CVS
08.2019 - 10.2022
Customer Service Specialist
Teladoc
10.2018 - 08.2019
Insurance Verification Specialist
DaVita Rx
02.2013 - 10.2018
Insurance Billing and Coding Specialist Diploma -
Concorde Career Institute
Diploma -
West Jefferson Senior High School