Tiffiny M. Email & Phone Number

Specialized knowledge with Medicare inpatient, psych, and rehab claims including billing and adjudicated claims. Strong analytical and problem-solving skills with knowledge of medical claims adjudication, denials, editing, appeals and other processes. Knowledgeable of Workers Compensation claim processes in varied states as well as state Medicaid programs. Strongest skill set includes identifying discrepancies/errors, researching the issue and providing solutions.

Listed skills include Auditing, Coordination Of Benefits, Current Procedural Terminology, Accounting, and 29 others.

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  Payment Policy Analyst

  Burgess

  Jun 2021 - Present

  • Support the implementation of and adherence to Medicare and Medicaid payment systems (including MS-DRG, APR-DRG, CMG) by analyzing payment laws, policies, methodologies, rates/algorithms, and regulations. • Deliver business requirements in the form of user stories and acceptance criteria for translation of Medicare and Medicaid payment models into claims reimbursement and editing software; complete user acceptance testing for production updates. • Develop and maintain subject matter expertise of Medicare and Medicaid payment methodologies specific to Medicare Acute Inpatient, Long-Term Care Hospitals, Inpatient Rehabilitation Facilities, Inpatient Psychiatric Facilities, Critical Access Hospitals, and Inpatient Medicaid programs. • Respond to client requests for identified issues and/or ad hoc requests that may come from outside the established requirements workflow; collaborate with development and quality assurance teams to ensure implementation of the needed business, functional and system requirements. • Provide legislation summaries, memos, implementation guides, and training tailored for varying audiences (ex: internal and external stakeholders, health plans, software developers, technical writers). • Conduct inquiries to the Centers form Medicare and Medicaid Services and other government organizations, including State Medicaid Departments to clarify existing billing and payment policies.