TIFFINY HENRY
San Antonio
Summary
Dynamic professional seeking to advance a career within an organization that values strong organizational, administrative, and teambuilding skills. Committed to leveraging innovative thinking and technology to enhance the customer experience for internal and external stakeholders. Proven ability to drive process improvements that contribute to operational excellence and customer satisfaction. Eager to contribute to a forward-thinking team dedicated to achieving impactful results.
Overview
13
13
years of professional experience
Work History
Senior Complaint Professional
Humana Military, Resolutions Team
06.2018 - Current
- Manage all aspects of the second-level Humana Military grievance process for the TRICARE East Region, ensuring compliance with grievance processing criteria specified in the TRICARE East Region contract
- Triage and analyze designated categories of complaints from TRICARE beneficiaries and healthcare providers, appropriately addressing their concerns and issues within time frames defined in policy
- Gather and consolidate TRICARE beneficiary satisfaction results for internal and external stakeholders for trends and opportunities for improvement
- Collect, organize and analyze data on beneficiary satisfaction through TRICARE surveys, focus groups, and other feedback mechanisms. Use statistical tools to analyze the data and identify patterns and trends, and prepare reports to communicate the results to management and other stakeholders.
- Ensure submission of contractually required reports on a monthly and quarterly basis
- Monitor the disclosure of Protected Health Information (PHI) by network providers within the TRICARE East Region to include tracking each encounter and facilitating provider notification of the potential breach
- Perform assigned functions associated with customer relationship activities, such as coordinating meetings, publishing agendas and minutes, and facilitating discussions of interventions and outcomes
- Responsible for managing Humana Military activities associated with customer relationships to include government, beneficiary, and provider satisfaction
- Manages special projects/programs as assigned by leadership
- Respond in precise, comprehensive and timely manner to beneficiary, provider, and Government inquiries regarding eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics.
- Implement, track and complete self-managed tasks to process and correct uncomplicated general eligibility, enrollment, billing, claims, referral/authorization, and network difficulties experienced by TRICARE customers.
- Research and resolve difficult, complex TRICARE problems/issues elevated by a Government agent, beneficiary, or provider within required timelines. Implement self-directed activities to analyze, coordinate, process, and complete action to correct multifaceted problems relating to eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics.
- Research and resolve complaints lodged on social media platforms from beneficiaries and providers.
- Perform claims research
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Adaptable and proficient in learning new concepts quickly and efficiently.
TRICARE Consumer Specialist
Humana Military, Regional Operations
12.2014 - 06.2018
- Gather beneficiary satisfaction data from government vendors and assemble reports to be used by business owners to trend and identify opportunities for improvement
- Prepare and distribute Beneficiary Satisfaction Summaries for all MTF’s in accordance with contract requirements
- Prepare, mail and/or email Executive Summaries to all civilian inpatient facilities in the South Region that are surveyed by the government
- Review/update Humana Military Customer Experience Management Policy as needed
- In the absence of the Regional Grievance Manager, process grievances from beginning to resolution
- Complete contract required Quarterly Grievance Assessment and verify Monthly Workload Report
- Created and utilized internal grievance audit process
- Assist with processing Second Level Review grievances to ensure they are completed within contract guidelines. Assist with research when needed
- Review, distribute and track administrative quality complaints assigned to field associates for processing within policy requirements
- Implement change in processing complaints received through Complaint Review Application (CRA)
- Prepare Agenda/Handouts for monthly Service Solutions meeting
- Review, sort and prepare MTF Complaint Summary for distribution to Business Owners for responses and action
- Upload government required reports into eCommerce as needed
- Collaborate and maintain positive working relationship with Beneficiary Satisfaction Analyst, TRO-E
- Complete special projects as needed or assigned
Training Coordinator
Medtronic Diabetes, Educational and Training Department
12.2012 - 12.2014
- Provide support to the Customer Sales and Support Training Team through interaction with trainers, trainees, management and other various departments
- Maintain training and classroom schedules, schedule guest speakers and obtain associated presentations to include Executive meetings, and other Medtronic Business units
- Prepare pre-training instructions/expectations and communicate information to training participants and their supervisors/managers/directors
- Maintain Training Team SharePoint website, calendar and training materials on the team share drive
- Administer eLearning modules, online exams, and post training evaluations via Articulate and Saba People Cloud
- Enroll and maintain Articulate database
- Assign and track e-learning modules, providing reports to supervisors and managers as needed
- Liaise with subject matter experts regarding instructional design and creating tutorials
- Troubleshoot employee issues accessing on-line e-learning modules
- Maintain training documentation for auditing purposes
- Maintain training data spreadsheet and roll into Training Team dashboard and Balance Scorecard
- Assist with special projects, process invoices and POs, and assist with training budget
- Investigate and test new, state of the art training and developmental tools and technology
- Assist in assessing training needs for new and existing employees
- Develop training aids such as manuals and handbooks
- Travel arrangements using American Express and Expense Reporting
Education
Masters of Business Administration - Healthcare Administration
Columbia Southern University
Huntsville, AL06.2019
Bachelors of Science - Business Administration
University of Maryland Asia Division
Sasebo, Japan12.2011
Skills
- Complaint management
- Data analysis
- Customer relationship management
- Data reporting
- Training coordination
- Quality assurance audits
- Strategic thinking
- Time management
- Teamwork and collaboration
- Effective communication
- Process improvement
Timeline
Senior Complaint Professional
Humana Military, Resolutions Team
06.2018 - Current
TRICARE Consumer Specialist
Humana Military, Regional Operations
12.2014 - 06.2018
Training Coordinator
Medtronic Diabetes, Educational and Training Department
12.2012 - 12.2014
Masters of Business Administration - Healthcare Administration
Columbia Southern University
Bachelors of Science - Business Administration
University of Maryland Asia Division