Tiffany Peach

Handle day to day activities within reimbursement services ( benefits investigation, prior authorizations and appeals support). Complete medical and/or pharmacy benefits investigations, identify and facilitate submission of required documentation for payer/plan review for prior authorization, step edit identification and appeals according to program standard operating procedures.

• Processed eligibility and benefits verification and authorization requests.
• Maintained high standards of customer service by building relationships with clients.
• Built relationships with clients through active listening and communication talents to provide excellent service.
• Serve as primary point of contact for patients and physicians in reviewing patient insurance information to meet program requirements
• Conduct benefit investigations to capture patient's healthcare coverage details.
• Interpret benefit investigation results to overcome barriers to patient access by supporting pre-certification, prior authorization and/or appeal processes.
• Communicate with insurance companies and other payers to track results of coverage decisions.
• Document all interactions and calls within case management database.
• Maintain HIPPA compliance at all times.

Maintain a professional, calm and friendly demeanor. Express thoughts and instructions clearly in both verbal and written communication; i.e. uses grammatically correct and concise language. Conduct insurance verifications to understand if patient's prescribed therapy is eligible for coverage. Coordinate prior authorizations; investigate alternative insurance coverage, or other funding sources on behalf of the patients per the program specifications. Document results in appropriate tracking system. Process patient applications and follow the program specifications to determine their eligibility. Document results in appropriate tracking system and manage follow-ups as appropriate.

• Quickly and efficiently respond to incoming calls and faxes, identify how best to assist.
• Process patient applications of various complexities, and follow the programs specifications to determine their eligibility, place follow up calls and respond to enquiries from patients and/or healthcare providers as necessary.
• Liaise with partner distributors and pharmaceutical manufacturers to request products per the program's guidelines and track shipments.
• Coordinate the order and transfer of prescriptions based on their degrees of urgency to specialty pharmacies as appropriate.
• Be familiar with the market place and the insurance options available for patients. Educate patients on the available options as appropriate.
• Assist with training new team members by shadowing/reverse shadowing them and serving as a data checker by reviewing data entered in the program's tracking system.
• Received incoming phone calls and contact form submissions and provided timely responses to inquiries.

Evaluated and improved mortgage customer service and compliance with protocols and quality assurance guidelines by agents. Identified common customer issues, improved customer experience and helped standardize communication processes with customers. Completed special projects as assigned.

• Reviewed, evaluated and scored delinquency management, loss mitigation and customer service contact calls, ensuring compliance with FDCPA, CFPB and internal operating standards.
• Assisted in training agents and provided clarification for compliance updates, changes and areas of improvement, alerting agents about process coming up for change before job aid was updated.
• Provided feedback and reporting on compliance and quality to agents, ensuring accurate information from job aids and process were being followed and provided correctly to borrowers.
• Reviewed focused sets of calls, with analytics input, assessing against specific business criteria.
• Collaborated cross-functionally in project to create evaluation scorecard and guidelines, improving quality of department-specific customer service calls and ensuring relevant evaluation of quality in areas, including delinquency management, liquidation or bankruptcy.
• Reviewed calls from dissatisfied borrower's queue, ensuring customer complaints were being forwarded to correct department or feedback was sent back to Team Lead to coach agent.
• Teamed up with QA Specialist in Rubric Peer Calibration, listening to and evaluating agent call, ensuring QA representatives saw and understood each other's views of call, noting if something was missed and ensuring all QA Representatives were evaluating lines same way.
• Reviewed adjustment request with Team Lead and QA with each providing view on how they evaluated disputed line, giving opportunity for Team Lead to identify points that needed to be adjusted or upheld.
• Performed Global Calibration with QA Manager, sending test call through NICE system for Team leads, AVP's and QA to evaluate, ensuring both were in sync with each other.

Communicated with customers and 3rd parties regarding potential default (or imminent default) to advise and facilitate an acceptable workout agreement involving liquidation of property to avoid further foreclosure action. Partnered with team members and leadership to achieve corporate objectives and incentives.

• Documented variety of account issues for inbound and outbound calls in accordance with policy and procedures and standards, directing calls to appropriate department as needed.
• Investigated and clarified escalation calls from agents, resolving customers concerns or complaints.
• Teamed with other Subject Matter Expects (SME), Team Leads and AVPs in weekly meetings for any process changes or concerns within in call enter or team, ensuring everyone received consistent information in order to advise team.
• Conducted listen-and-review calls with agents, coaching agents to more effectively resolve customer issues.
• Ensured calls handled by agents met SLA guidelines by monitoring queue.
• Performed side-by-side live monitoring calls with agents, enhancing timely resolution and using available resources to provide accurate information.
• Provided reinstatement and payoff quotes to clients.
• Discussed property liquidation options with customers.
• Reached out to borrowers to discuss current status and loan workout options.
• Observed all regulatory, compliance and security policies and procedures to keep data as safe as possible from breaches.
• Handled customer complaints with relative ease by conducting research, listening carefully and taking appropriate action.