Tiffany Anderson-King

EDUCATION

University of PhoenixMasters- MBA/MHA Healthcare Administration and Management (Exp. December, 2016)

University of Phoenix Alumni Spirit of Service Award January 2016

Presidential Lifetime Service Award – President Obama March 2016

University of PhoenixBachelor of Science- Healthcare Administration and Management (July, 2013)

Hampton University & Brookhaven CollegeAssociates in Science & Arts Magna cum Laude- (May 2007)

U. S. Army Veteran (1997-2005)/ADSW Recruiter (2003-2005)

EXPERIENCEFebruary 2014 - Current Concentra Addison, TXGroup Health Contract Administrator/CPR-Adult Emergency Certified

Maintain timely documentation of credentialed providers and facilities. Complete Reimbursement Analyses in negotiating contracts Review and compare payer contracts thru a redline process. Responsible for all notifications for any business changes (billing address,

relocations, and closings) to all payers for all lines of business. Conduct audits of all contract summaries for all lines of business Administrator for payer websites manage passwords and additional users Conduct audits for verification, internal reports, contracts, and all lines of

business Special Projects at discretion of VP, Director's or Manager. Member of the Focus Committee - Responsible for implementing ideas and

processes that improve the morale within department. Maintain and Manage Medicare and Medicaid payers/providers Create and maintain files and reports for internal and external stakeholders

according to specific contract for 200+ payers Responsible for completing monthly Power Point and interactive Health

Presentations for the Department Meetings.

April 2013- February 2014 Concentra Plano, TXReferral Coordinator

Processed referrals and authorizations for Concentra Medical Centers and works closely with physician(s)/physician(s) representatives, employers and payers to achieve a positive impact on the outcome cost and quality of care rendered to the injured employee, in accordance with Concentra policies, practices, procedures and applicable regulations. Reports to Client Support Services Director.

Reviewed/Processed all diagnostic/specialty/miscellaneous referral requests by Concentra Medical Centers.

Tiffany Anderson-King

Obtained authorization for referrals and schedules appointments as appropriate.Assured referrals are maintained within appropriate networks/MSOs. Communicated with all stakeholders, payer, and employer, patient as appropriate and as per protocol.

Recorded all appropriate information via OA/CR module of OccuSource per Policy & Procedure. Built relationships with provider and payer community.

Reviewed/Processed PT/Specialist/Diagnostic Authorization requests by Concentra Medical Centers.

Obtained authorization from payers as per protocol and scheduled patient appointments.Provided all necessary information (medical records, scripts, etc) to payer.Records all appropriate information via OA/CR module of OccuSource per Policy & Procedure.

Handled calls according to the call guidelines and will participate in the quality assurance process that involves the monitoring and recording of calls with follow up coaching.

Provided special treatment and services for selected customers. Provided coverage for other markets and centers, when requested.

September 2009- June 2012 Kemper Services Group, Dallas, TXSubrogation/Medical Casualty/Litigation/UM Claims Adjuster

Responsible for the review and recovery of property damage, medical, uninsured and litigation claims.

Confirmed coverage, Negotiated settlement with third party carriers/attorneys or uninsured claimants;

Sent out subrogation/collection demands; verify out of pocket expenses, issue payments to third party carriers, claimant’s and insured’s.

Ordered medical records with written consent or medical authorizations, determining if claims are suit worthy, filing arbitration or litigation claims, running asset checks, background checks and retrieving or ordering police reports. Negotiated settlement of claims.

Experience with working directly with attorneys on filing law suits, Arbitration, Litigation and completing affidavits for litigation and medical claims.

SKILLS

Public/Motivational Speaker and Published Author. Proficient with MS Office: Word, PowerPoint, Excel, Outlook, Access, Internet Explorer, Internet functions, 50 wpm, Legacy, Eagle soft, Focus, Next Gen, Guide wire, Choice point, SharePoint, Accurint, CCC Portal, Copart, Business Objects, CACTUS, and Citrix Neighborhood.