Tiffany Paniel Email & Phone Number

Raleigh-Durham, North Carolina Area

• Director of Client Implementation: August 2015 -PresentRegional Director, Physician Services: May 2007-August 2015Credentialer/Scheduling Coordinator/Recruiter: April 2006-May 2007
• Manage the onboarding implementation process and workflow of hospital EM, FSED's, Urgent Care’s, CC/ICU, HM, Tele, and new Innovation programs.
• Track the life cycle of implementation for all departments for consistent startup outcomes.
• Prepare quick reference guides and forms to assist with best practices.
• Facilitate meetings as needed for progress updates until post go-live.
• Liaison between business development and operational teams for new client handoff.

Raleigh-Durham, North Carolina Area

• Implementation of the hospital enrollment process for Duke University, Durham Regional and Duke Health Raleigh Hospitals
• Completed and submitted contract applications for North Carolina and out-of-state insurance plans in all states on behalf of the hospitals for the purpose of obtaining provider numbers compliant with NCQA standards
• Assisted Private Diagnostic Clinic Physicians in completing contracts associated with provider enrollment
• Work with C Suites staff at Duke to obtain authorized signatures, confidential hospital credentials, and business documentation required to complete and submit enrollment paperwork for each hospital entity
• Implementation of National Provider Identifiers and the Undocumented Workers plan
• Daily phone follow-ups with insurance plans such as Medicaid, Medicare, and other Managed Care carriers to ensure applications are processed timely and resolve any issues that may delay processing

Raleigh-Durham, North Carolina Area

• Provide administrative support to clinical trials SAS programmers
• Data entry of clinical trials behavioral health pharmacy data
• Create spreadsheets and edit reports
• Provide support, research, and billing suggestions with CPT and ICD-9 coding issues

Raleigh-Durham, North Carolina Area

• Subject matter expert for clinician enrollment/billing process and guidelines for assigned team.
• Liaison between physicians, PhyAmerica, and insurance companies.
• Obtained applications for $5million of billable claims due to company merger.
• Coordinated enrollment projects of clinicians with Medicare, Medicaid, and Managed Care carriers for fee-for-service clients.
• Enrollment presentations during onboarding medical director orientations.
• Presentations to include status of projects, accounts receivables, and monetary hold amounts.

Raleigh-Durham, North Carolina Area

• Answered incoming calls from medical providers as well as members of the insurance plan regarding medical benefits, claims payments, and policies of the State Health Plan and NC HealthChoice
• Traveled and presented insurance benefit information at Blue Cross workshops for potential insurance carriers in an effort to increase enrollment and insurance sales.
• Assisted in training new hires on Blue Cross software system and daily job duties to become independent workers
• Followed up with various departments regarding the status of open cases for claims adjustments and medical review
• Documented all inquiries that required adjustments and gave explanations of claims processed both verbally and via correspondence