Tiffany Funk

***** ******** ********* **** **** Thornton, CO 80233

720-***-****

adwr33@r.postjobfree.com

Objectives

To obtain a position that will utilize my expertise and skills and that will allow room for growth and movement with opportunities to learn and grow not only in knowledge but as a person.

Education

DeVry University

07/2015 Associate’s Degree Health Information Technology

•Dean’s List for three semesters

•RHIT certified

Cambridge College

06/2001 Associate’s Degree Allied Health – X-Ray Tech/Medical Assisting

Experience

Ledgent/Roth Staffing – For US Nursing/Fastaff

Payroll Specialist Temp 08/04/2022 – 03/27/2023 REMOTE

•Phone Customer Service

•Payroll Document Processing including Federal W4’s, Direct deposit information, and State Payroll forms for various states, to include entering the proper municipality localities for states with locality requirements.

•Providing customer service for various states during Job actions in states like California, Michigan, New York, and Oregon.

•Help in processing daily pay in required states during job actions.

•Weekly timesheet processing for New York client.

•Analyzing and processing of Kronos times entry weekly.

•Processing payroll corrections daily.

•Research and analyze any issues in pay from nurses including benefits, taxes, FLSA, 401K, bonuses, non-taxable pay.

•Securely emailing documents to nurses – ie: 2022 W2 & Paycheck stubs.

•Meet all deadline requirements for responsibilities and projects by staying organized and prioritizing my tasks.

Soul Dogs, Inc.

Admin. Assistant/ Billing Specialist 01/27/2022 – 05/02/2022 REMOTE

•Serve as internal consultant and subject matter expert on billing project engagements and Therap.

•Identify and recommend client business process improvements.

•Facilitate and manage software development life cycle activities (Therap), such as requirement sessions.

•Communicate and/or translate business challenges.

•Serve as liaison between various stakeholder groups and other third-party vendors.

•Demonstrate and further develop an understanding of the Medicaid market, which includes understanding Medicaid programs and service delivery by participating in training courses, online learning, or through learning from more experienced colleagues.

•Accounts Payable - reviewed invoices for term correctness based on client contracts and submitted to Executive Director for payment.

•Developing relationships with state clients, health plans and/or vendors to compare products, services and technical too.

•Contribute to project work plans, and other formal project management deliverables relative to project initiatives.

•Contract Analysis - review external vendor and managed care organization contracts, state plans, federal waivers, and other documents (e.g., policies, manuals) to ensure compliance with regulatory requirements and contract standards or to develop best practice contract requirements for a client.

•Clinical Analysis - review and analyze encounter, claims, utilization, performance measure, and other data to look for trends and patterns and to inform clinical recommendations.

•Generates weekly billing data and sends professional claims to each funding source through Therap including Medicaid Waiver billing and Medicaid billing.

• Generates weekly caseload-based reports for director audit purposes; upload reports into SDI Income sheet.

•Collaborates with directors regarding any errors found in the billing process and to resolve any back billing situations.

•Performs audits on denied claims and identifies, documents, resolves and/or escalates issues to the appropriate level.

InterDent

CBO Specialist 11/16/2021 – 12/15/2021 REMOTE

•Researching and reconciling A/R accounts for all government and commercial payors

•Resolving past due patient accounts

•Proving required documentation to insurance companies based on ERA Remittance or

and/or denied EOB’s.

•Communication with all dental offices to find such required information.

•Use all Open Dental, NEA/FastAttach, clearinghouses, government, and commercial website use.

•Communication with insurance companies to resolve payment issues.

Cascade Oral & Facial Surgery

Insurance & Billing Specialist 10/08/2021– 10/31/2021 Lake Oswego, OR

•Verify Insurance benefits/coverage for patients prior to their appointments.

•Provide patients accurate cost estimates based on their insurance coverage.

•Billing/coding

•Submitting claims

•Claims follow up.

•Research and resolve insurance billing issues.

•Receives and sort incoming payments and posts payments in a timely manner.

•Handles complex coordination of benefits for patients with more than one type of insurance.

•Prior authorization processing

Infinity Rehab, Inc.

Insurance Specialist 3/8/2021– 7/19/2021 REMOTE

•Insurance verification - verify benefits with Medicare and verify eligibility with commercial and HMO insurances via phone and internet.

•Insurance authorization - contact insurance companies for pre-authorization.

•Establish and maintain accounting practices to ensure accurate and reliable data necessary for business operations including Accounts Receivable, Accounts Payable and General Ledger.

•Sets up patient accounts in billing software program.

•Accounts Receivable - Collections as needed, private pay and insurance.

•General Office: Filing, faxing, and mailing, attending team meetings, and other duties as needed.

•Assists with preparation of financial related materials as needed.

•Assists with other activities as directed by supervisor or Executive Team.

•Assists with back up entering of charges/billing into billing software program.

HealthCare Outsourcing Network

Insurance Follow-Up Specialist 9/8/2020 – 1/4/2021 REMOTE

•Analyzing insurance payments and denials, looking for reasons for shirts pays and denials and figuring out why there is an amount still outstanding.

•Calling insurance companies or sending needed documents required from the insurance company to close and receive payment on the claim using the EMR in our customer’s EPIC system, contacting customer is needed information is not in the patient record, contacting the patient is the information needed can be obtained from the patient or is needed directly from the patient to the insurance company.

•Analyzing the payment record if there is an outstanding balance that does not match the EOB(s) on file and figuring out if there is an error in posting or in payment and getting that error resolved.

Concentrix

Sr. Advisor II, Transaction Processing 7/30/18 – 4/17/20 REMOTE

•Analyzing CMS 1500 claims for payment for Arizona Medicaid program to include doctor office, surgery, maternity, OT/PT/ST for pediatric and adults, in and outpatient, radiology, pathology, anesthesiology, skilled nursing and others when needed.

•Checking for COB of other insurance, checking files for proper prior authorizations required for processing, making sure all necessary elements are in place prior to authorizing a payment, processing required claims through McKesson for proper processing including reduction of payment and denial due to bundling, checking patent history to confirm allowable and max procedures, checking images in two systems to verify patient information, and needed information such as anesthesiology times.

•Verifying ICD-10-CM diagnostic codes and modifiers for proper processing

Bioscrip,Inc.

Reimbursement Specialist 11/13/2017 - 7/30/2018 Aurora, CO

•Processing Home Infusion claims in CPR+ for commercial, Medicaid, Medicare, and patient pay for all types of home infusion billing, including Chemo, Chelation, Enteral, IVIG, SCIG, Hydration, Anti-Emetic, and other therapies for most states across the US

•Processed Credit/Rebills.

•Completed Collections projects.

•Worked on Medicare claims across the US as well.

•Printed and sent secondary claims as needed.

•Looked for all required documentation for each insurance as required including DIF’s, AOB’s ABNs, and more as determined but insurance type regulations. If documentation was not there or was out of date, the claim was placed on hold.

•Created CMN’s including initial and revised.

•Worked on the held report for Medicare.

•Released older claims when documentation was presented, and claims could be released.

•Scanned documentation into an MRO electronic documentation system and organized into date and type folders.

•ICD-10-CM coding and diagnoses verification for proper reimbursement and processing.

•Verifying EDI submissions and correcting any errors.

Authentic Home Care Inc.

HR & Billing Director 05/08/2017 – 11/10/2017 Aurora, CO

•Weekly Medicaid billing including Adult Day Care Services and HCBS and IHSS professional claims.

•Analysis and reconciliation of all insurance payments and research and follow-up for any non-payment items.

•Primary Insurance UB-04 claims/1500 claim submissions.

•PAR submissions for Medicaid for Long Term Home Health Pre-authorizations and In Home Services Support – Adult.

•EMR system integration from paper records to Cashe and training of all office employees.

•Collect and audit employee charting per pay period per Medicaid regulations.

•Process payroll through Wells Fargo for over 90 employees, both bi-weekly and monthly, including any garnishments and child support processing.

•Created billing tracking system prior to EMR system.

•Coding for 485’s and Adult Assessment tools if needed.

•Doctor DORA verification and NPI verification.

•OIG Exclusion verifications.

•DORA verification for employee’s licenses.

•Run background checks prior to employment.

•ICD-10-CM diagnosis coding for submission of PAR to state of Colorado

Special Angel, LLC

Owner 10/2015 -02/2017 Aurora, CO

•Weekly Medicaid billing Primary Insurance UB-04 claims/1500 claim submissions.

•485 reviews for proper codes and tracking for Pre-Authorization submissions.

•PAR submissions for Medicaid for Long Term Home Health Pre-authorizations and In Home Services Support.

•EMR system integration from paper records twice.

•Created training manuals for new system charting for CNA’s.

•Collected and audited CNA charting weekly per Medicaid regulations.

•Reported CNA hours weekly for payroll.

•Created billing tracking system prior to EMR system.

•Insurance claim denials and reprocessing.

•Coding for 485’s and Pediatric Assessment tools if needed.

•Doctor DORA verification and NPI verification.

•ICD-10-CM/ICD-9-CM diagnosis coding for PAR approval and CPT coding for proper claim submission

All For Kid’s Home Health

Parent CNA 10/27/2015-11/30/2016 Denver, CO

•24/7 CNA tasks for my special needs son

Evergreen Home HealthCare

Parent CNA 09/2014 -10/2015 Aurora, CO

•24/7 CNA tasks for my special needs son

Comfort Dental

Office Manager 05/01/2011 – 05/2013; 02/2001 - 02/2002 Aurora, CO

•Billing for all insurances.

•Credentialing for all providers.

•Scheduling of all providers and employees.

•Insurance denials.

•Accounts Receivables.

•Processing of all Insurances payments and patient payments.

•Calculating patient treatment plans.

•Patient check-in and out.

•Proper ICD-9-CM CPT coding for proper reimbursement on procedures and visits.

•Applications for becoming In Network providers for all Dentists in the practice.

•Fees/Rates tracking and negotiation.

•Payment posting for insurance checks and patient payments.

•Research patient refunds

•Front Office Employee Scheduling

Marubeni-Itochu Steel America, Inc

Sales Coordinator 10/2006 – 04/2011 Nashville, TN

•Purchase Orders.

•Created and tracked monthly steel orders from raw material to steel coil processing –

utilizing vlookup and many other formulas.

•Price negations with new customers.

•Tracked all shipments of customer orders.

•Created sales reports monthly.

•Prepared sales meeting notes and presentations.

Skills

•Medical Assistant Degree

•X-Ray Technologist – Limited Scope Degree

•RHIT certified.

•Full Cycle Revenue Management

•Cash Posting

•EOB’s

•Denials/Appeals

•Client/Personal collections

•Various Medical backgrounds including dental.

•Very quick in learning new software systems and processes.

•Microsoft Office - Word, Excel, PowerPoint

•50 wpm & 10 key

•Pediatric and Adult Home Health billing

•Full cycle billing including appeals, resubmissions, re-openings, and research.

•Medicaid billing and PAR system

•Physician Credentialing

•Medicaid Pediatric waiver programs

•Medicaid/Medicare experience

•Payroll and Taxes including FLSA

•Phone center customer service

•EDI, ERA, and EOB experienced

•CPR+

•CMS 1500 & UB-04 knowledge

•ICD-10-CM/ICD-9-CM diagnosis coding

•CPT coding for various disciplines

•Oasis Review for PAR submissions and entry into EMR system

•EDI Clearinghouse systems – Availity

•Dentrix

•Dental Coding

•NDC Codes

•Customer Service

•eCentral

•EPIC

•Cerner

•Dentrix

•Open Dental

•Fast Attach

•Fastnotes

•Therap

•eRecruit

•PeopleSoft

•UKG

•Cashe

•AS400

•Kronos

•Quickbooks

•Workday

References

Danielle Sherman – Supervisor adwr33@r.postjobfree.com 720-***-****

Dr. Jeffrey Varner– Owner/Dentist adwr33@r.postjobfree.com 303-***-****

Nicole Seletz – Senior Business Solutions Manager adwr33@r.postjobfree.com 720-***-****

Alexandra Wuerstl – Co-Worker adwr33@r.postjobfree.com 720-***-****

Sandra Rodriguez– Coworker adwr33@r.postjobfree.com 720-***-****

More references available upon request

Contact this candidate