Tiffany Collins Davis
Summary
Reliable individual bringing 28 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
25
25
years of professional experience
Work History
Utilization Review Specialist
HCA
Remote
08.2021 - Current
- Overseeing the daily office processes to ensure a steady workflow
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon admission specification.
- Served as subject matter resource, providing information related to insurance situations.
Utilization Review Specialist
HCA
Remote
08.2021 - Current
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon admission specification.
- Devise or identify solutions for irregular requests and issues.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Patient Financial and Insurance Specialist
Vanderbilt Medical Center
Nashville, TN
05.2019 - 08.2020
- Maintained and updated insurance information for all patient files
- Processed eligibility and benefits verification and authorization requests.
- Maintained confidentiality of patient finances, records, and health statuses.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
- Researched and resolved routine and complex issues.
- Monitored changes in insurance industry to stay compliant with relevant laws and regulations.
- Processed and certified documents for accuracy and compliance with government regulations.
Scheduler II
HCA
Nashville, TN
03.2014 - 07.2019
- Verified insurance coverage and obtained pre-authorizations.
- Maintained confidentiality of patient information to comply with HIPAA regulations and protect patient privacy.
- Verified insurance coverage and eligibility for medical services prior to scheduling appointments to prevent billing issues.
- Collaborated with healthcare staff to verify alignment of appointment scheduling with clinic protocols.
- Developed and implemented efficient scheduling systems to maintain organized medical appointment schedules.
- Managed complex calendars for multiple medical practitioners, verifying accuracy of all appointments.
- Oriented and trained new staff on proper procedures and policies.
- Liaised with patients and addressed inquiries, appointment requests and billing questions.
Patient Access Representative
Vanderbilt Medical Center
Nashville, TN
07.2013 - 03.2014
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Trained new staff on hospital processes and procedures.
Patient Financial Services Representative
Memorial Regional Hospital South
Hollywood, FL
09.2001 - 07.2012
- Researched billing errors and discrepancies to initiate corrective action.
- Responded to customer inquiries and provided detailed account information.
- Analyzed customer financial records to determine appropriate payment plan.
- Entered client details and notes into system for interdepartmental access and review.
- Verified insurance coverage and obtained pre-authorizations.
- Managed multiple schedules and prioritized tasks to meet demands of fast-paced work environment.
- Led employee relations through effective communication, coaching, training, and development.
- Cultivated positive, productive team environments, resolving conflicts quickly.
- Maintained confidentiality of patient information to comply with HIPAA regulations and protect patient privacy.
- Processed payments and managed financial records to facilitate proper billing and tracking of payment history.
Education
High School Diploma -
James Rickards High School
Tallahassee, FL05.1995
Skills
- Ability to accurately obtain, record, and process information
- Knowledge and capability to explain documents and insurance coverage to patients
- Office Management/ Department Lead
- Proven dedication to provide exceptional patient satisfaction
- Knowledge of medical terminology
- Experienced Electronic Medical Records: Epic Super User, Meditech, EHR applications
- Coordinate schedules
- Skilled in insurance verification, and authorization notification/retrievals
- Administrative support
- Professional phone etiquette and multi-line phone handling
- Daily prioritization and general office function duties
- Hands of experience in financial collections, financial counseling and daily department
- Deposits
- EMR Systems
- Creative Thinking
- Patient Admission
Timeline
Utilization Review Specialist
HCA
08.2021 - Current
Utilization Review Specialist
HCA
08.2021 - Current
Patient Financial and Insurance Specialist
Vanderbilt Medical Center
05.2019 - 08.2020
Scheduler II
HCA
03.2014 - 07.2019
Patient Access Representative
Vanderbilt Medical Center
07.2013 - 03.2014
Patient Financial Services Representative
Memorial Regional Hospital South
09.2001 - 07.2012
High School Diploma -
James Rickards High School