TIFFANY HALL

**** ****** ** ****

Raleigh, North Carolina 27614

H: 919-***-**** E-Mail: adpgwn@r.postjobfree.com

OBJECTIVE: APPEALS ANALYST

Research and investigation ~ Current Procedural Terminology ~ ICD-9~ Document Creation

Healthcare Common Procedure Coding System ~ Claims Experience ~ Executive Support

Dependable professional with 15 years of experience providing effective and comprehensive administrative support.

Supported the Director of Audit and Reimbursement Manager with my extensive experience implementing organizational strategies and measures resulting in continuous improvements and efficient business operations.

Detailed oriented, self-starter who meets project deadlines and requirements while performing multiple tasks within fast paced environments.

Efficient, resourceful and reliable team player that will meet individual goals and support the company’s mission.

Outstanding written and oral communication, quickly establishing rapport and building relationships with all levels of the organization, while maintaining confidentiality.

. . .”Superb job you and your team did leading the P.I.E activities-it was spectacular!”

Neal Burkhead, Executive Senior Vice-President, BCBSSC

RELATED PROFESSIONAL EXPERIENCE

Cahaba Safeguard Administrators, LLC

Administrative Coordinator 2006-Present

Administrative

Performed general administrative duties including the provision of telephone support, management of internal and external mail, ordered office supplies, and monitored the maintenance of office equipment.

Responsible for taking all departmental minutes and maintained records for all meetings.

Helped developed the company’s internal software program to track and maintain auditor workloads.

Responsible for receiving new work in for the auditors, identify if any requested information was missing and contacted providers for follow up via phone or email.

Developed training processes for receiving and returning work sent by MAC’s.

Trained new hires on the internal software in the areas that I was responsible for.

Maintained spreadsheets for manager tracking work process for all auditors

Maintained receipts and invoice for monthly reconciliation and reporting.

Travel with investigations staff and nursing staff to onsite to assistant with investigations at medical facilities across North Carolina.

Responsible for organizing community service/ volunteer events for the company staff to participate for charitable support in the community.

TIFFANY HALL PAGE 2

Blue Cross Blue Shield of South Carolina, Durham, North Carolina

Medicare Secondary Payer II (MSP)/Subrogation Analyst 2001-2006

Administrative

Research, review, and resolve over 900 Medicare beneficiary cases while exceeding departmental quality standards and meeting CMS government deadlines.

Develop and maintain a computerized database for use at customer service office in Florida; exporting data on a daily basis.

Mentor and train new staff on policies and procedures about MSP and Right of Recovery.

Generate letters and address phone calls from attorneys, insurance companies, and beneficiaries regarding Medicare liens and meet with customers to resolve.

Write monthly newsletter with articles about events and achievements.

Streamlined outgoing correspondence process to increase productivity and accuracy by 85%.

Event Coordination/Planning

Designed and administer several employee recognition programs.

Assist Senior Operations Director in recommending ways to improve employee morale.

Plan, organize, and present at monthly quality recognition staff/management breakfasts.

Develop PowerPoint presentations to introduce roll out of new changes/developments.

Coordinate and organize planning of Annual Employee Day with over 200 attendees within budget of $10,000.

Boosted staff morale and improved teamwork by coordinating the P.I.E. (Partners in Excellence) Quality Awards program to recognize employees on a daily basis.

Achievements

Established the Divisional Quality Council in Durham.

Awarded several Quality Awards for 0% error rate.

Contributed to team’s goal of $152 MM in revenue collection that was 11.8% greater than prior year’s goal.

Blue Cross Blue Shield of North Carolina, Raleigh, North Carolina

Customer Service Specialist 2000-2001

Addressed over 100 customer calls (policyholder, family members, and providers), daily, on health benefits and verifying eligibility on consumer group policies and HMOs.

Selected to cross-train on new product line of five individual insurance polices.

Chosen to serve on Executive Task Force to improve employee morale/customer service.

Value Options, Research Triangle Park, North Carolina

Behavioral Health Coordinator-Call Center 1998-2000

Addressed and resolved over 85 calls, daily, from providers and members verifying and determining eligibility of behavioral health benefits.

Approved mental health treatment benefits for members of over 50 companies.

North Carolina School Boards Association, Research Triangle, North Carolina

Administrative Assistant 1996-1998

Liaison with over 40 workers’ compensation claimants to discuss injuries and pay claims.

Analyzed medical records and researched and reviewed provider requirements to determine eligibility of claims for treatment under Workers’ Compensation.

Completed and certified forms to be sent for approval to North Carolina Industrial Commission.

Screened telephone calls, sorted and distributed mail.

Developed and maintained departmental files and tracking systems to ensure timely payment and all information was easily accessible to appropriate staff.

Achievements:

Ensured 100% of files were completed to maximize efficiency of check payment.

Created weekly Excel reports for adjusters on workload, claims, and payment status.

TIFFANY HALL PAGE 3

Holiday Inn Reservation Center, Cary, North Carolina

Customer Service Representative 1993-1995

Addressed over 150 customer questions, daily, regarding hotel locations and reservations for Holiday Inns, worldwide. Handled irate customers, effectively.

Assessed customer needs and up sold 40% of customers impacting $312,000 revenue.

OTHER PROFESSIONAL EXPERIENCE

High Seas Travel Agency, Raleigh, North Carolina

Owner/Travel Consultant (Part-time) 1995-Present

Researched, planned, and selected best accommodations and travel arrangements within budgeted dollars growing business to over $10,000, annually.

Specializing in cruises, domestic and international air, and hotel and rail reservations.

PROFESSIONAL TRAINING

Blue Cross Blue Shield of South Carolina ongoing professional training in:

Word Basic/Intermediate/Advance, Excel Basic/Intermediate/Advanced, Compliance/HIPPA, Privacy and Confidentiality, Service Plus Fast Tracker, Medical Terminology, FISS Training/ReMAS, ICD-9 Coding, Publisher, Outlook, PowerPoint

EDUCATION

Wake Technical Community College, Raleigh, North Carolina

Business Curriculum (24 credit hours completed) 1993-1995

American Institute for Paralegal Studies

North Carolina State Bar Certified Paralegal 1991-1993

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