Customer Service Medical

Tammy Thibeault

Wood Cross, UT ***** ? Tel: 801-***-**** ? ***********@***.***

Quality Analyst Auditing, Claims Processing

Performance driven, detail oriented professional experienced in medical

coding, claims processing, auditing, customer service, and improving

processes. Experienced in reporting, modeling testing, medical benefits,

and staff training. Familiar with CPT, HCPCS, and IDCD9.

Core Competencies

. Medical Coding . Team Development & Leadership .

Healthcare Management

. Quality Assurance . Research & Problem Resolution .

Medical Benefits

. Auditing & Financial Analysis . Process Improvement .

Customer Service Excellence

Professional Experience

CAMBIA

1989

- 2014

Business Systems Analyst Support Services, 2013 - 2014

Audited product configuration products for accuracy and ensured that the

product matched medical benefits. Identified and reported documentation

issues. Wrote clear, concise audit findings and followed through until

resolution was reached and implemented.

. Nominated and received recognition bonus award for extraordinary

contribution to project audit.

. Met tight deadlines by discovering issues and getting issues resolved

before product effective dates.

. Introduced process to inform managers of weekly trends and the root cause

for errors. In addition, processors viewed mistakes and training gaps

sooner, resulting in higher monthly scores and improved customer

satisfaction.

. Consistently surpassed productivity and accuracy objectives, ensuring

policies and procedures were followed.

. Identified key items on medical products that would have processed

incorrectly including wrong deductible, out of pocket max, and preventive

and vision benefit not processing accurately on the build.

. Audited on/off exchange products and other medical products.

. Reduced costs by discovering errors. Audited system claims before it was

processed which prevented manual adjustment process.

Performance Integrity Analyst III, 2013

Compiled and submitted key operational reports. Audited manual and system

claims in their entirety which included pricing, procedures, HCPCS, ICD9,

units, providers, and modifiers. Conducted various sampling methods

for audits.

. Audited MTM claims, saving thousands of dollars and preventing potential

issues.

. Recognized as key contributor and coordinated and worked on special

projects for management.

. Met auditing and reporting deadlines, tracking timelines and goals.

. Provided ongoing support to team, answering questions and resolving

problems.

Performance Integrity Lead, 2010 - 2013

Led Quality team for timely delivery of audits. Researched and supported

team with complex issues, idea generation, and solutions. Met with external

auditors to ensure completeness and accuracy of audits. Conducted

interviews and assisted management in hiring for audit positions.

. Managed team's Audit the Auditor samples, reporting, questions, and

challenges.

. Handled escalated challenge appeals.

. Successfully identified and analyzed root causes of trends and prepared

reports.

. Boosted productivity by training and mentoring auditors and ensuring

consistent practices.

. Compiled numerous reports and communicated effectively with internal

departments and cross functional staff, keeping them informed of results.

. Kept management informed of staff needs and employee morale, wherein,

immediate supervisor and manager received the highest scores on employee

satisfaction surveys.

Performance Integrity Analyst II, 2007 - 2010

Managed, planned, and coordinated various audits including audits involving

performance guarantee groups. Wrote clear and concise audit findings.

Monitored inventory.

. Received Bonus Award for Extraordinary Achievement in auditing conversion

groups and identifying issues from the transition from the legacy system

to the Facets system.

. Increased efficiency and improved operational performance by creating a

process for Audit the Auditor program, reviewed challenges with

management, and maintained auditor reports.

. Participated in calibration calls and leadership team meetings.

Benefit Analyst, 2005 - 2007

Maintained and updated procedure code, IDC9 and HCPCS files. Implemented

benefit contract changes in APL system. Reviewed patient

records and assigned codes to diagnoses and procedures to ensure facilities

could bill insurance and patients.

. Teamed and worked closely with internal departments and medical services.

. Assisted in automating system to reduce staffing costs and tested system

before implementing changes to ensure accuracy.

. Analyzed benefits, resolved technical issues, and researched and reviewed

documentation

for completeness.

Claims/Data and Analyst/Lead, Cambia, 1989-2005

Processed and audited claims. Interpreted coding, analyzed claims, and

researched payments. Managed records and reviewed benefits.

. Prioritized and delegated work by closely monitoring workload and aging

inventories to meet deadlines.

. Handled customer inquiries while providing courteous, excellent customer

service.

. Increased performance and ensured adherence to policies and procedures by

training new, temporary, and existing employees in process guidelines.

Education

Health Care Management Major, GPA 3.4, Attended, Weber State

Medical Billing Certificate, GPA 3.7, Bryman Medical

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