Tiffany Rankins

• Serve as a key member of the Swing Team, providing rapid support across programs while managing shifting priorities
• Oversee high-priority escalations from Field Reimbursement Specialists (FRSs), Patient Access Liaisons (PALs), and Virtual Reimbursement Access Specialists (VRASs) in the Northern Region
• Execute detailed benefits verification for commercial, Medicare, and Medicaid plans, ensuring accurate coverage determination for Tezspire (tezepelumab-ekko)
• Coordinate prior authorization and appeals processes in collaboration with healthcare providers and payers to expedite patient access
• Manage Patient Assistance Program (PAP) eligibility and enrollment, facilitating access for uninsured and underinsured patients
• Administer copay assistance programs and maintain 48-hour follow-up timelines to resolve coverage barriers
• Achieved 100% quality and compliance audit scores, documenting all interactions meticulously in CRM systems

• Manage end-to-end case management for patients prescribed Tepezza (teprotumumab-trbw), ensuring comprehensive support from benefit investigation to treatment initiation
• Perform detailed benefits verification for commercial, Medicare, and Medicaid insurance plans
• Coordinate prior authorization submissions and appeals with providers and insurance carriers to secure timely approvals
• Assist patients in enrolling in PAPs and guide them through copay assistance processes to mitigate financial barriers
• Ensure regulatory compliance and maintain accurate documentation in CRM systems

• Manage patient cases for Prolia (denosumab) by conducting thorough benefits investigations and determining insurance coverage needs
• Facilitate prior authorization and appeals processes in partnership with healthcare providers
• Lead enrollment efforts for Patient Assistance Programs (PAPs) to secure affordable medication access for eligible patients
• Provide copay assistance support and maintain robust communication with specialty pharmacies and payers
• Consistently achieve high performance metrics while upholding HIPAA and CMS compliance

• Administered benefits verification and managed claims processing for an international client base under a global health insurance framework
• Resolved insurance queries, processed claims, and ensured adherence to policy guidelines through effective customer service
• Guided members through complex benefits structures, addressing coverage challenges and facilitating timely access to health services
• Collaborated with internal teams and external partners to implement process improvements that reduced turnaround times and enhanced claims accuracy
• Maintained meticulous documentation to ensure compliance with international regulatory standards

Utilization Management, Prior Authorization & Appeals Case Management

Aetna International-Tampa, FL

• Managed prior authorization requests for a wide range of medical services, ensuring compliance with insurance policies and industry regulations.
• Handled complex appeals cases, collaborating with healthcare providers and members to resolve denials and facilitate patient access to necessary treatments.
• Conducted thorough clinical reviews and assessments to determine the medical necessity of services, contributing to improved patient outcomes and efficient care delivery.
• Worked closely with cross-functional teams, including providers, internal departments, and external stakeholders, to facilitate the smooth processing of requests and resolve issues.
• Provided guidance and support to members, ensuring clear communication and timely resolutions of authorization and appeal inquiries.