Summary
Overview
Work History
Education
Skills
Websites
Certification
Timeline
Generic
Tiffany Laws

Tiffany Laws

Spartanburg

Summary

Developed skills within structured healthcare environment, including effective communication and problem-solving capabilities. Demonstrated ability to handle detailed documentation and compliance tasks with accuracy. Seeking to transition into new field, aiming to leverage these transferrable skills in dynamic setting.

Overview

2
2
years of professional experience
1
1
Certification

Work History

Provider Enrollment Specialist

Noridian Medicare
11.2024 - Current
  • Facilitated seamless transitions between different stages of the enrollment process by maintaining open lines of communication among various departments involved in provider services operations.
  • Streamlined provider enrollment processes by implementing efficient data management systems.
  • Troubleshot technical issues related to the online enrollment system, providing prompt resolutions for providers and internal stakeholders alike.
  • Assisted providers with navigating online portal systems, enhancing user experience and expediting application submissions.
  • Consistently met or exceeded departmental performance targets through diligent management of individual workload and effective collaboration with team members.

Supervisor

BroadPath
08.2024 - 11.2024
  • Seasonal Position – Licensed Supervisor on the UHC Medicare project for the AEP season for an INBOUND CALL CENTER for up to 30 calls per day. During this project, I coached agents in Medicare Sales Techniques and process on a daily, and weekly, basis while submitting coaching reports in QuickBase. Listened to calls in Qfiniti, Citrix, and Gensys to ensure quality metrics are met. I ensured schedule adherence by submitting exceptions and downtime reports, also in QuickBase. Built rapport with the agents on a team level so that I could boost morale, ensure proper sales tracking, and work to build quality metrics. Attended daily meetings to discuss metrics, expectations, and engagement strategies.

Analyst

BroadPath
12.2023 - 06.2024
  • Seasonal Position – Analyst in the TTY/PCE project for UHC during the off season for an INBOUND CALL CENTER for up to 30 calls per day. In this role, I write quality check questions, perform outgoing phone calls to PCE UHC agents, confirm that they are giving correct information to consumers / CMS, and input the call into TRIO for further review by the Operational Leadership Team. For the TTY portion, tested SimpliciTTY systems for agent use by pushing perimeters of the program with test case protocols. Once a bug was determined, a test case was written to notify IT/Dev support for a workaround so that agents using the system will be informed on outages, correct process, and updates.

Supervisor

BroadPath
09.2023 - 12.2023
  • Seasonal Position – Licensed Supervisor on the UHC Medicare project for the AEP season for an INBOUND CALL CENTER for up to 30 calls per day. During this project, I coached agents in Medicare Sales Techniques and process on a daily, and weekly, basis while submitting coaching reports in QuickBase. Listened to calls in Qfiniti, Citrix, and Gensys to ensure quality metrics are met. I ensured schedule adherence by submitting exceptions and downtime reports, also in QuickBase. Built rapport with the agents on a team level so that I could boost morale, ensure proper sales tracking, and work to build quality metrics. Attended daily meetings to discuss metrics, expectations, and engagement strategies.

Grievance and Appeals Provider Claims Service

Robert Half
01.2023 - 08.2023
  • Temp Position – Worked with Envolve Dental to provide Claims, Prior Authorization, and Benefit information to Members and Providers for an INBOUND CALL CENTER for up to 30 calls per day. Envolve Dental being the 3rd party vendor for Ambetter, Ascension, Wellcare, and State Medicaid for 14 states. With members, we discussed their current plan benefits, where to go see their in-network providers, and how much of their accumulated balance they had left out of their individual benefit maximum. With providers, we verified eligibility, discussed submitted claims and if they were denied, and what was required for claim submission. We check members’ benefits using the members’ CMS code for their plan and the CDT codes from the providers billing department. With the CDT codes we could ensure coverage, discuss frequency limits, and if there were any prior authorization requirements.

Education

High School -

Stratford High School
Goosecreek, SC
01.1999

Bachelors of Science - Business

University of Phoenix
07-2026

Associate of Arts - Information Technology

University of Phoenix
07-2024

Skills

  • Experience with Word, Excel, PowerPoint in Windows OS (XP to 11) format Pages, Keynotes, and Numbers in the Mac OS X format

  • Experienced with Salesforce, ServiceLive, Avaya, Genesys, PULSE, TRIO, QuickBase, Power BI, and Verint

  • Strong communication skills

  • HIPAA compliance awareness

  • Effective written and verbal communication

  • Leadership qualities

  • Data entry proficiency

  • Healthcare regulations

  • Training and mentoring

Certification

  • Technical Support Fundamentals Certified through Google
  • Python for DevOps Certified through Coursera
  • Residential Health Insurance License

Timeline

Provider Enrollment Specialist

Noridian Medicare
11.2024 - Current

Supervisor

BroadPath
08.2024 - 11.2024

Analyst

BroadPath
12.2023 - 06.2024

Supervisor

BroadPath
09.2023 - 12.2023

Grievance and Appeals Provider Claims Service

Robert Half
01.2023 - 08.2023

High School -

Stratford High School

Bachelors of Science - Business

University of Phoenix

Associate of Arts - Information Technology

University of Phoenix

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Tiffany Laws