Tiffany Washington

Experience

• 

  Medco Health Solutions Inc

  Oct 2007 - May 2013

  Customer Service Representative /Grievance Support Representative (PEGA)

  Answers customers request or inquiries concerning medication, billing, and claims.Work in multiple queues/skill sets over various customer contact channels.Continually maintain working knowledge of all company policies.Make recommendations according to the customers medication needs.Utilize operational systems to process payments on accounts.Assist CSR’s with properly documenting patient concerns after ensuring the representative has taken every action possible prior to documenting the members concern and directing the member to the proper team to assist with formally documenting the members complaint according to Medicare guidelines.Assist with new hires transition from training to being successful in their new role with various techniques outlined by management. Show less

• 

  Humana Behavioral Health

  Dec 2013 - now

  Process request from clinical care managers for assistance with care and service needs in a timely manner, prioritizing the referrals according to defined levels of urgency, securing member behavioral health appointments and services as necessary and communicating referral information to back to the care manager. Develop and maintain computerized record management system to store and process data such as personnel activities and information, and produce reports.Assist with patient contact regarding resources via mail or phone if needed. Assist Care manager and patients in problem solving potential issues related to the behavioral health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance). Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient access to care and services.Partners with Network Development to ensure behavioral health network is adequate for the geography and escalates accordingly when network adequacy impacts access to care. Develop and assist in implementing organizational policies and procedures.Demonstrate respect for the privacy and confidentiality of patient’s protected health information Show less Identify the needs of clients and maintains documentation on each case in a secure system to ensure privacy and confidentiality of each clients protected health information. Communicates with others (internally or externally) to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or complaints. Explains program services and policies, makes referrals to internal programs, or community resources. Prepare correspondence and materials for management.Collect, compile, prepare and maintain reports, records, files and data. Show less

  • Healthcare Finder

    Mar 2017 - now

  • Behavioral Health Referrals

    Dec 2013 - Mar 2017