TiQuanna Fisher
Summary
Dynamic professional with extensive experience in administrative functions, benefits administration, and client support. Proven ability to streamline processes and enhance service delivery, contributing to overall organizational efficiency. Eager to leverage and further develop a diverse skill set in a challenging role that fosters growth and innovation. Committed to delivering exceptional results while supporting team objectives and enhancing client satisfaction.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Senior Process Executive
Cognizant Healthcare
12.2021 - Current
- Adjudicated HCFA & UB92’s in Workflow
- Coached processors
- Processed physician and hospital appeals/grievances
- Resolved check issues (refunds/overpayments)
- 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
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
Senior Disability Advocate
Sedgwick Claims Management
09.2021 - 11.2021
- Processed approximately 30-35 claimants Short-Term disability claims daily
- Certified/Approved short-term disability payments to claimants
- Contacted claimants, doctor offices, and employers to gather information pertaining to claimants ongoing disability status
- Sent out daily correspondence to claimants regarding the life of their claim.
Process Executive
Cognizant Healthcare
01.2021 - 07.2021
- Adjudicated & processed approximately 95-120 HCFA & UB92’s in Workflow daily
- New day claims only
- Routed claim issues to appropriate department(s) for resolution
Claims Examiner/Fact Finder
Apple One- Maximus
10.2020 - 12.2020
- Adjudicated approximately 55-60 unemployment claims on pending cases
- Daily outgoing calls to employers and employees regarding benefit claims
- Performed daily updates to spreadsheets and was responsible for system corrections regarding employee(s) claims
Client Support-Lead
EBS- WORKTERRA
09.2015 - 04.2020
- Processed verification documents for enrollment of dependent benefits (health, child dependent life, dental/vision). Approximately 50 daily
- Provided administrative support to Client Executive’s on individual blocks of business year-round, and during OE
- Resolved any issues/help requests via JIRA tickets submitted by the Executives (IE: enrollment/system issues, rate and benefit plan building, and providing any assistance needed with maintaining system behavior)
Claims Analyst- Lead
Hills Physicians Medical Group
02.2014 - 09.2015
- Processed Commercial and Medi-Cal lines of business claims for professional services rendered.
- Routed claims to the appropriate department to properly adjudicate claims for payment.
- Ensured that that ICD-9 and CPT codes were valid and appropriately assigned.
- Processed Appeals/Grievances
Claims Analyst II
Health Plan of San Joaquin
05.2010 - 05.2012
- Adjudicated Medi-Cal and Stanislaus claims in QNXT system
- Maintained a 97% accuracy level in non-payment and 98% in payment quality
- 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
- Analyzed claims data to identify discrepancies and ensure accurate processing.
Education
Certificate of Completion - Medical Billing and Coding
University of Phoenix
Phoenix, AZ09.2019
High School Diploma -
John C Fremont High School
Oakland, CA01.1995
Skills
- Claims processing expertise
- Prior authorization management
- Appeals
- Standard Operating Procedures
- Data Entry
- Case Load Handling
Certification
- Certified Billing and Coding Specialist (CBCS) Eff: 7/2020 Exp: 7/2022
- System Knowledge: JURIS, TAMMS, QNXT, AS400, WORKTERRA, Medi-Tech, QNXT, EMR systems, and WebAdmin
Timeline
Senior Process Executive
Cognizant Healthcare
12.2021 - Current
Senior Disability Advocate
Sedgwick Claims Management
09.2021 - 11.2021
Process Executive
Cognizant Healthcare
01.2021 - 07.2021
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 - 05.2012
Certificate of Completion - Medical Billing and Coding
University of Phoenix
High School Diploma -
John C Fremont High School
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