TIFFANY HORN
Canton,MS
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
24
24
years of professional experience
Work History
Program Coordinator I
Magnolia Health Plan
05.2017 - Current
- Research claims inquiry specific to the department and responsibility
- Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care
- Initiate authorization requests for output or input services in keeping with the prior authorization list
- Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results
- Assess and monitor inpatient census
- Screen for eligibility and benefits
- Identify members without a PCP and refer to Member Services
- Screen members by priority for case management (CM) assessment
- Coordinate services with community based organizations
- Attend marketing and outreach meetings as directed to represent the plan
- Produces and mails routine CM letters and program educational material
- Data enter assessments and authorizations into the system.
Durable Medical Equipment Biller
Hometown Medical LLC
04.2016 - 05.2017
- Process durable medical claims w/Medicare (HMO)/ Medicaid and commercial payers through Brightree systems
- Acted as liaison between facilities, insurance payers and patients to ensure claims were processed and paid accordingly
- Provide customer service to patients
- Thoroughly investigated past due accounts and minimized number of delinquent accounts
- Ensure claims are entered and submitted within timely filing limits of insurance companies
- Appropriately and correctly identified errors and re-billed rejected claims
- Reconcile insurance and patient payments
- Compose end of the month financial reports.
- Reduced billing errors by implementing strict policies and systematic procedures.
Government Billing Specialist II- Team Lead
University of Mississippi Medical Center
09.2011 - 04.2016
- Thoroughly investigated past due accounts and minimized number of delinquent accounts
- Ensure claims are entered and submitted within timely filing limits of insurance companies
- Appropriately and correctly identified errors and re-billed rejected medical claims
- Reconcile insurance and patient payments
- Work refunds and credit balances.
- Improved billing accuracy by implementing a streamlined invoicing process.
- Reduced errors in financial records by conducting regular audits of billed accounts.
- Maximized revenue potential by identifying and resolving under-billed accounts.
Third Party A/R Collections Team Lead
Pharmerica
02.2007 - 06.2011
- Allocate and oversee the daily workload for team to ensure proper processing of pharmacy invoices and billed pharmacy claims
- Contacted customers in an effort to cure delinquent balances on accounts
- Participated in departmental projects and coordinated with management to report accurate and timely results
- Thoroughly investigated past due accounts and minimized number of delinquent accounts
- Acted as a liaison between patient and payers in resolving billing and reimbursement accuracy
- Appropriately and correctly identified errors and re-billed rejected pharmacy claims.
Medical Billing Clerk
Hinds Behavioral Health Services
03.2004 - 02.2007
- Processed and billed medical claims- (Medicaid/ Medicare/Commercial Insurances)
- Provided customer service support daily
- Scheduled appointments and secured billing information
- Insurance verification /Account collections
- Behavioral health billing - entered outpatient physician charges.
- Improved cash flow by effectively following up on unpaid claims and resolving discrepancies between billed and received amounts.
- Maintained accurate patient records, updating demographic information and insurance details as needed for a seamless billing process.
- Handled sensitive patient information with utmost discretion, maintaining strict confidentiality in accordance with HIPAA regulations.
School Based Clinics Billing Supervisor
G.A. Carmichael FHC
01.2000 - 03.2004
- Oversee the workload for school based clinics billing staff
- Schedules Appointments
- Medical and dental billing - entered medical, lab, and dental charges
- Monitored school clinics intake and billing.
- Streamlined invoice processing for timely payments by enhancing the tracking system and automating data entry tasks.
- Enhanced team productivity by providing ongoing training, guidance, and support to billing staff members.
- Oversaw the proper allocation of payments received from various sources, ensuring accurate posting to relevant accounts and facilitating efficient reconciliations at monthend.
Education
Healthcare Administration -
University of Phoenix
Phoenix, AZBusiness/Accounting -
University of Southern MS
Hattiesburg, MSGraduated -
Canton High School
Canton, MS05.1995
Skills
- Computer Proficiency- Epic/AS400, SSI/Med Asset, NexGen, Med Analytics, Brightree, Novitas, TruCare, OMNI, CRM
- Data Analysis
- ICD-9, ICD-10, Medical Terminology
- Medical (hospital and physician)/ Behavioral Health/Pharmacy/Ambulance/Dental Billing, Durable Medical Equipment
- HIPPA compliance/CMS regulations
- Claims Entry & Payment Posting
- Insurance verification/Patient Aging /Refunds
- Eligibility Determination
- Referral Coordination
- Scheduling Proficiency
- Decision Making
- Organizational Skills
Timeline
Program Coordinator I
Magnolia Health Plan
05.2017 - Current
Durable Medical Equipment Biller
Hometown Medical LLC
04.2016 - 05.2017
Government Billing Specialist II- Team Lead
University of Mississippi Medical Center
09.2011 - 04.2016
Third Party A/R Collections Team Lead
Pharmerica
02.2007 - 06.2011
Medical Billing Clerk
Hinds Behavioral Health Services
03.2004 - 02.2007
School Based Clinics Billing Supervisor
G.A. Carmichael FHC
01.2000 - 03.2004
Healthcare Administration -
University of Phoenix
Business/Accounting -
University of Southern MS
Graduated -
Canton High School
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