Tiffany Dean
Reimbursement Analyst III at SKYGEN- Claim this Profile
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Bio
Credentials
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Engage the Likability Effect in the Job Search
LinkedInJun, 2022- Nov, 2024 -
Interpersonal Communication
LinkedInJun, 2022- Nov, 2024 -
Tips for Working Remotely
LinkedInJun, 2022- Nov, 2024 -
SQL: Querying and Managing Data
Khan AcademySep, 2015- Nov, 2024 -
Tableau Creator
TableauSep, 2015- Nov, 2024
Experience
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SKYGEN
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United States
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Hospitals and Health Care
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300 - 400 Employee
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Reimbursement Analyst III
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Aug 2021 - Present
Ensures company compliance with federal and state laws, including reporting requirements.Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.Resolve complex Encounter inquiries by analyzing data and related enrollment, claims, and authorizations recordsUses SQL, data models, data element dictionary and schema to perform data and business analysis.Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.Analyzing information and evaluating results to choose the best solution and solve problems.Setting strategic vision.Thoroughly analyze claims processing to ensure minimum 90% accuracy SLA.Identified and implemented claim processing improvements which decreased processing time by 30%.Regularly evaluating provider pain points decreasing erroneous claims by 17%.Manges employee training for all new recruits over a 6-month period, with continuous mentorship.Works closely with configuration team and DBAs to ensure synchronicity of configuration to interface and mappings.Establishes and maintains positive and effective work relationships with coworkers, clients, members and providers. Show less
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Reimbursement Analyst
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Oct 2015 - Aug 2021
Performed a thorough analysis and accurately recording patient information to determine the appropriate reimbursement amount to dental providers. Ensured all payments and procedures adhere to regulations and plan guidelines as outline in Provider agreements with Medicare and Medicaid.
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Provider Relations Representative
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Sep 2013 - Oct 2015
Researched claim and reimbursement questions.Worked with internal departments to produce, maintain and deliver provider training references andmaterials. Worked with call center to resolve outstanding follow ups generated from incoming calls. Resolved member access to care issues by arranging letter of agreement with out of network providers. Maintained updated data on client owned provider networks. Acted as a liaison between providers and clients to resolve escalated contracting and fee issues for client owned provider networks. Worked with internal departments to resolve provider complaints. Show less
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Customer Service Representative
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Dec 2011 - Sep 2013
Handled large volumes of escalated calls from Members, Providers and state level complaints.Assisted providers and members with benefit plan coverage and limitations, dental and vision authorizations and claim inquiries.Assisted members with access to care issues.Maintained a high level of customer satisfaction with forward-thinking strategies focused on addressing client needs and resolving concerns.Cultivated customer one call resolution resulting in decreased call volume.Answered calls promptly to reduce on-hold wait times. Show less
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Education
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1995 - 1999
James Madison High School
High, General Studies
Community
