TIFFANY FREEMAN

*** *. ****** ****** ** Reno, OK. 73036 · 405-***-****

Work Email: ad1msw@r.postjobfree.com

Personal Email: ad1msw@r.postjobfree.com

Analytical, dependable, self-organized and detail-oriented Coding Analyst with over 6 years of experience in the full spectrum of claim production. Collaborative team player with an ownership mentality and a track record of delivering the highest quality strategic solutions to resolve challenges, and propel business growth.

PROFESSIONAL EXPERIENCE

2015 TO PRESENT

Centene Corporation, LLC Farmington, Mo

Claim Analyst, Nov 2015-March 2016

Advanced Analyst, March 2016-Dec 2017

Coding Analyst, Dec 2017-May 2021

Business Analyst II May 2021-current

Claims Analyst

Review and processing pended claim according to work processes.

Process daily spreadsheets in a timely manner.

Advanced Analyst

Resolve complex claims, claim appeals, inquires, and inaccuracies in payment of claims.

Review and maintain appeal work baskets so they are processed in a timely manner.

Assists supervisor and team leads to research and determine status of medical claims to ensure they are consistent with work processes and CMS guidelines.

Traveled to Tempe, AZ to assist with training of a new site.

Mentored new and advanced analyst throughout training.

Backup Team Lead.

Assist in creating work processes for the department and support team members in understanding changes in work processes.

Primary contact for the team when the lead is out, for the plan and for other departments in researching, collecting information and documentation to address various issues.

Maintained daily reports and monitored inventory daily.

Assigned worked and tasks to other analyst as needed.

Reviewed claims manually processed to ensure accuracy prior to check run.

Review IA and QRT errors to track and identify trends.

Analyzed trends in errors identified and compiled reports to provider management with results and possible solutions.

Coding Analyst

Review and process high dollar claims for appropriate place of service, length of stay, match to authorization, and possible outlier DRG or stop loss pricing.

Review provider contracts and ensure the claims were processed according to their contract to avoid provider abrasion.

Conduct complex business and operational analyses to assure payments are in compliance with provider’s contract; identify areas for improvement and clarification for better operational efficiency.

Work collaboratively with various cross-functional departments to determine appropriateness of pricing.

Work collaboratively with Medical Management Department to resolve any issues with medical review notes that effect high dollar claim pricing.

Serve as a technical resource/coding subject matter expert for contracting pricing related issues.

Responsible for entire cycle of high dollar claims which includes verifying information on submitted claims, reviewing contracts, compliance guidelines, state regulations, eligibility, and authorizations to determine reimbursement, and releasing claim for payment.

Identify key elements and processing requirements based on diagnosis, provider, contracts and policies and procedures utilizing broad based product or system knowledge to ensure timely payments are generated.

Conduct point of service review and resolution of high dollar claims that are pending and/or adjusted incorrectly including review, investigation, adjustment and resolution of claims, claims appeals, inquiries, and inaccuracies in payment of claims.

Collaborate with all departments to analyze complex claims issues and special claim projects which are identified through high dollar review

Review inventories to determine appropriate task to complete first and key performance indicators are met

Manage and provide testing on new product or system configuration to determine success rate of such product or configuration prior to go-live

Business Analyst II

Collaborate with the claims department to price pended claims correctly.

Audit check run and send to the claims department for corrections.

Analyze trends in claims processing issues and assist in identifying and providing solutions.

Research providers’ claims inquiries as needed and provide resolution.

Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication.

Mentored new hires to assist in training and demonstrated new concepts to the team.

Document, track and resolve all plan providers’ claims projects

2013-2015

Startek Inc, Farmington, Mo

Engagement Specialist, Dec 2013-June 2014

Senior Lead Support, June 2014-- Nov 2015

Service customers via inbound or outbound calls for the purpose of resolving customer issues with products or services while providing superior customer service. Focus on one call resolution for all customers ensuring all avenues for solving the customer issues that are evaluated.

Engagement Specialist

Responded to over 60 phone calls per day from customers with diverse needs and personalities, while resolving complex issues with professionalism and diplomacy.

Maintained and or exceeded call performance quality goals (i.e. calls per hour, transfer rate, etc.)

Maintained and or exceeded call quality goals (i.e. greeting, presentation, closing, etc.)

Troubleshooting any problems the customers may have with their device.

Work to understand the unique perspective of the customers wants, needs, and priorities in order to improve their interaction with the Company.

Senior Lead Support

Oversaw the day to day operations of over 300-500 Engagement specialist.

Assisted Engagement specialists with system knowledge, de- escalation techniques, and customer escalations.

Assisted assigned supervisors and/or managers with daily processes including call monitoring, directing the training of new Engagement specialist, and providing quality assurance assistance.

Lead a culture of accountability through clear expectations and performance management on critical services and engagement behaviors.

EDUCATION

MAY 2018

ASSOCIATES OF APPLIED SCIENCE

OFFICE SYSTEMS TECHNOLOGY – MEDICAL CODING

Mineral area college, park hills, mo

GPA: 3.4/4.0

SKILLS

Compliance

Microsoft word & excel

Spreadsheets

Exceptional oral and written communication

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