TiQuanna A. Fisher
Roanoke,TX
Summary
Experienced in administrative, benefit administration, and client support roles. Seeking a position to utilize and expand acquired job skills. Passionate about delivering exceptional support and contributing to team success. Eager to take on new challenges and make a positive impact in a dynamic work environment.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Claims Adjudicator
Judi Health
10.2025 - Current
- Process claims efficiently, ensuring adherence to company policies and regulatory guidelines.
- Evaluate documentation for accuracy, maintaining high standards of compliance
- Collaborate with healthcare providers to verify patient information, benefits and coverage
- Identified discrepancies in claims submissions, facilitating timely resolutions and minimizing errors.
- Approve/deny authorizations based on medical necessity
- Prior authorization verification
- Insurance verification
Senior Process Executive
Cognizant Healthcare
01.2021 - Current
- Evaluate HFCA and UB92 forms within workflow.
- Train and team members on processing techniques.
- Process physician and hospital appeals/grievances
- Resolve check issues (refunds/overpayments)
- Process appeals per appeal letters received by provider.
Claims Examiner/Fact Finder
Apple One- Maximus
10.2020 - 12.2020
- Adjudicated unemployment claims on pending cases (DNA, VL, MC, AA, OP, NU’s)
- Conducted daily outbound calls to employers and employees about benefit claims.
- Updated spreadsheets daily and handled system corrections related to employee claims.
Client Support-Lead
EBS- WORKTERRA
09.2015 - 04.2020
- Processed verification documents for enrollment of dependent benefits (health, child dependent life, dental/vision)
- Delivered administrative support to Client Executives for individual business blocks throughout the year.
- Addressed and resolved issues and help requests submitted by executives through JIRA tickets.
Claims Analyst- Lead
Hills Physicians Medical Group
San Ramon, CA
02.2014 - 09.2015
- Managed processing of claims related to professional services in Commercial and Medi-Cal domains.
- Directed claims to relevant departments for accurate adjudication.
- Validated and assigned ICD-9 and CPT codes accurately.
- Facilitated processing of appeals and grievances.
Claims Analyst II
Health Plan of San Joaquin
French Camp, CA
05.2010 - 01.2014
- Adjudicated Medi-Cal and Stanislaus claims in QNXT system
- Maintained a 97% accuracy level in non-payment and 98% in payment quality.
- Medical Collections- Reviewed aging account receivable reports monthly and processed accounts as needed. Arranged payment plans prior to sending patients to the collection department for escalations.
- Processed appeals per appeal letters received by provider. Received appeals and reviewed provider contracts, checked the system for possible updates to contracts, and adjusted claims to make corrections as needed to initial denials.
Workers Comp Claims Assistant
ICW Group
Pleasanton, CA
08.2007 - 01.2009
- Supported Senior Claim Examiners in managing high-volume caseloads.
- Distributed C&R and award payments to relevant claimants and parties.
- Delivered necessary benefit and DWC notifications to claimants.
Education
Certificate of Completion - Medical Billing and Coding
University of Phoenix
09.2019
High School Diploma - undefined
John C Fremont High School
01.1995
Skills
- Administrative Support
- Benefit Verification
- Commercial Insurance
- Medi-Cal Insurance
- Medical Claims Processing
- Prior Authorization
- Standard Operating Procedures
- Indemnity Claims
- AME/QME appointment setups
- Coordination of Benefits
- Data Entry (advanced)
- 10-Key (advanced)
Certification
- Certified Billing and Coding Specialist (CBCS) Eff: 2020-07 Exp: 2022-07
- System Knowledge: JURIS, TAMMS, QNXT, AS400, WORKTERRA, Medi-Tech, QNXT, EMR systems, and WebAdmin
Timeline
Claims Adjudicator
Judi Health
10.2025 - Current
Senior Process Executive
Cognizant Healthcare
01.2021 - Current
Claims Examiner/Fact Finder
Apple One- Maximus
10.2020 - 12.2020
Client Support-Lead
EBS- WORKTERRA
09.2015 - 04.2020
Claims Analyst- Lead
Hills Physicians Medical Group
02.2014 - 09.2015
Claims Analyst II
Health Plan of San Joaquin
05.2010 - 01.2014
Workers Comp Claims Assistant
ICW Group
08.2007 - 01.2009
High School Diploma - undefined
John C Fremont High School
Certificate of Completion - Medical Billing and Coding
University of Phoenix