Tiffany Montoya
@tiffanymontoya
Seasoned healthcare analyst committed to patient-centered service delivery.
United StatesWhat I'm looking for
As a seasoned Healthcare Account Coordinator, I am dedicated to enhancing service delivery through my extensive management and customer service experience. My expertise lies in strategic planning and processing, which allows me to achieve superior outcomes in patient care while ensuring operational efficiency.
Currently, I serve as an Appeals Analyst at Blue Cross Blue Shield, where I analyze coverages, review insurance claims, and resolve disputes with a strong knowledge of HIPAA regulations. My previous roles have equipped me with a solid foundation in claims processing and customer service, enabling me to manage high volumes of appeals efficiently.
I am passionate about contributing to a patient-centered approach in healthcare, leveraging my bilingual skills in Spanish to communicate effectively with diverse patient populations. I am committed to continuous improvement and excellence in all aspects of my work.
Experience
Work history, roles, and key accomplishments
Appeals Analyst
Blue Cross Blue Shield Ins
Jan 2025 - Present (5 months)
Analyzed coverages, reviewed insurance claims, and resolved disputes. Verified CPT/ICD-10-CM diagnosis and HCPCS codes, tracked paperwork, and analyzed medical records, ensuring HIPAA compliance.
Patient Care Coordinator
Robert Half
Oct 2024 - Dec 2024 (2 months)
Performed data entry, acted as an insurance specialist and customer service representative, adhering to HIPAA and insurance guidelines. Managed EMR accounts, authorizations, patient registration, and scheduled appointments.
Customer Member Service Specialist II
Health Equity
Dec 2021 - Oct 2022 (10 months)
Performed data entry, administrative assistance, and claims processing, while also serving as a customer service representative. Managed two teams of 16 people, ensuring time-sensitive deadlines for claims and monthly audits were met with minimal supervision.
Claims Analyst
MHN Corporation
Dec 2021 - Oct 2024 (2 years 10 months)
Processed claims, acted as an insurance specialist and customer service representative, and led the claims team for mental health. Collected payments, ensured timely and correct claim payments, and adhered to HIPAA and insurance guidelines for Medicare and Medicaid.
Education
Degrees, certifications, and relevant coursework
Devry University
Medical Billing and Coding Program, Medical Billing and Coding
Completed a comprehensive program focused on medical billing and coding principles. Gained expertise in healthcare revenue cycle management and claims processing.
Silverado High School
High School Diploma, General Studies
Obtained a high school diploma, completing foundational studies across various subjects. Developed essential academic skills and prepared for further education.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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