Tiffany Taylor
Richmond
Summary
Healthcare professional skilled in optimizing operations and fostering strong provider relationships. Demonstrates advanced problem-solving abilities and the capacity to manage multiple priorities in fast-paced environments. Committed to enhancing service delivery and operational efficiency through strategic initiatives and collaborative partnerships.
Overview
10
10
years of professional experience
Work History
Network Relations Lead
SCAN HealthPlan
Houston
01.2023 - Current
- Resolved complex issues and collaborated with managers to implement effective solutions
- Serve as primary contact for medical groups, providers, hospitals and ancillaries and act as a key liaison between the providers/entities and the health plan
- Closely partners with Contracting to facilitate an integrated onboarding experience, leading project management planning for cross-functional onboarding efforts and establishing a robust playbook
- Establish and maintain excellent relationships with the provider network, with efforts focused on assigned region
- Conducted provider orientation and ongoing training to enhance relationships and improve service delivery
- Conducts regular provider office visits within assigned geographic region
- Investigates and responds to escalated provider concerns and issues
- Participates in data driven operations meetings with assigned network of providers, corporate leadership and internal SCAN stakeholders
- Creates educational materials and formal presentations to support provider touchpoints and initiatives
- Supports cost and quality performance monitoring of the provider network, and liaison for training on deficiencies
- Coordinates data extracts and data analysis interpretation
- Partners with Contracting on network adequacy and robustness of local provider access and reputation to evaluate the need for additional providers; supports on internal awareness of network changes
- Acts as a key liaison for network needs to support clinical programs or growth efforts
- Coordinates efforts to ensure SCAN and its contracted providers follow regulatory requirements
- Provide leadership, coaching, and/or mentoring to group
- Supports on internal company initiatives/projects/process improvements that further improve provider experience
- Promoted value-based care strategies to improve healthcare delivery
- Onboarding of new IPAs and Medical Groups
- Identified and addressed barriers to improve provider collaboration and strengthen network relationships
Network Management Consultant Medicare Advantage
Blue Cross Blue Shield
Houston
03.2021 - 01.2023
- Develops and maintains positive provider relationships with provider/groups by communicating administrative and programmatic changes, facilitating, education and the resolution of provider issues
- Manages Value Base Agreements & pricing
- Host and facilitates value based JOCs (Joint Operating Committee meetings)
- Maintained provider rosters to support effective communication and service delivery.
- Processed incentive payouts and agreements to support provider engagement and performance.
- Led project management efforts to coordinate resources and meet project deadlines.
- Supports network expansion
- Identified network access deficiencies and developed recruitment strategies to enhance provider participation
- Serves as a communication link between professional providers and the company
- Assist in efforts to enhance ease of use of the provider portal
- Handle inquiries from physicians, which are received by phone or email which can include billing, network status or provider issues
- Obtains and analyzes financial performance and quality metrics
- Developed and maintained contact database and disseminated communications to providers.
- Collaborates with provider contractors and network relations reps to meet provider service needs
- Encouraged providers to engage in patient outreach initiatives to improve care coordination
- Conduct provider DSNP training
- Coordinated claims resolution by directly collaborating with providers and internal departments to ensure timely processing
- Identifies and reports on provider utilization patterns which have a direct impact on the quality- of-service delivery
Provider Engagement Representative & Medicare Territory Representative
Amerigroup
Houston
07.2019 - 03.2021
- Provider outreach and network
- Fostered strong relationships with key providers by coordinating partnership meetings and identifying on-site enrollment opportunities for marketing
- Develops and maintains positive provider relationships with provider community by communicating administrative and programmatic changes
- Managed provider requests for demographic information, ensuring accuracy and efficiency in processing tax identification numbers and new addresses
- Enhanced ease of use of provider portal
- Addressing multifaceted provider issues with innovative solutions
- Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues
- Liaised between physicians, members, clinical staff, and ancillary departments to enhance member and physician satisfaction
- Support development and management of provider network
- Effectively communicate with executive/upper leadership, clinical and front-line stakeholders
- Identify areas of concern
- Research issues and identify root cause
- Process improvement and research
- Participate in planning and contributing to the success of corporate and community events
- Contributed to alignment of organizational goals with business strategies
- Handle inquiries from physicians, which are received by phone or email which can include billing, network status or provider issues
- Assisted in credentialing and re-credentialing process to ensure providers' applications are correct and expedited
- Manage the implementation and development of the community and drive sales of Medicare products
- Create detailed work plan spreadsheet which includes expected spend
- Project management
- Create detailed work plan spreadsheet which includes expected spend
Patient Business Services Coordinator
Memorial Hermann Medical Group
Katy
06.2016 - 03.2019
- Supervising and overseeing daily operations
- Serve as a preceptor, mentor and resource for the less experienced staff
- Assign, delegate, monitor workflow and manage the activities of direct reports
- Managed scheduling and office functions to ensure smooth daily operations
- Provides ongoing training, coaching, and development of staff to meet performance expectations, gathers the most accurate financial and demographic information for each patient encounter, and provides the highest possible customer service
- Conducted interviews and hired staff to build a skilled and effective team
- Monitored quality improvement, identified barriers, and recommended changes to enhance service delivery
- Monitored work to ensure compliance with standards by reviewing policies and procedures
- Comply with the department budget, time management, supply budget, productivity and accuracy of clinic, monitors cost reports
- Manages key scheduling and registration processes by monitoring and reporting performance statistics and explaining variances and adjustments
- Ensuring accuracy and completion of eligibility, insurance verification, prior authorizations, collection of TOS payment, past due balances
- Revenue cycle, budgets, charge lag reports, monthly operating reports and zero pay report
- Demonstrates accountability for cost effective management of resources (equipment and supplies) while ensuring the department achieves patient care goals
- Create and update records and databases with personnel, financial and other data
- Conducted podcast for the entire medical group
- Compliance audits, claims auditing and researching claims information
- Claims filing accuracy/processing and completion of missing slips
- Coordinated project activities to achieve defined objectives and maintain workflow.
- Ensure the development, business objectives, and clinic goals are met
- Member of the signs and forms committee
- Educating providers on new programs, systems, policy procedures, and technology including process improvements.
Education
Bachelor of Science Degree - Allied Healthcare Management
Franklin University
Columbus, OH05-2013
Certificate in Medical Assistant -
The Cleveland Institute of Medical And Dental Assistants
Cleveland, OH03-2002
Skills
- Stakeholder Engagement
- Provider Relations
- Claims Administration
- Revenue Cycle
- Managed Care
- Project Management
- Budget management
- Financial Reporting
- Quality Improvement
- EHR
- Computer Systems & Software Application
- Microsoft Office
- Scheduling & Calendar Management
- Office Management & Organization
- Strategic Planning and Business Development
- Staff development
- Problem Identification & Resolution
- Engagement
- Presentations
- Strategic Planning and Business Development
References
Available Upon Request
Timeline
Network Relations Lead
SCAN HealthPlan
01.2023 - Current
Network Management Consultant Medicare Advantage
Blue Cross Blue Shield
03.2021 - 01.2023
Provider Engagement Representative & Medicare Territory Representative
Amerigroup
07.2019 - 03.2021
Patient Business Services Coordinator
Memorial Hermann Medical Group
06.2016 - 03.2019
Bachelor of Science Degree - Allied Healthcare Management
Franklin University
Certificate in Medical Assistant -
The Cleveland Institute of Medical And Dental Assistants