Tiff Powell

about

I am a healthcare claims and payment integrity professional with more than a decade of experience in claims processing, auditing, coding validation, recovery, quality control, and operational improvement. I investigate claim discrepancies, identify root causes, validate coding and pricing accuracy, interpret contracts and benefit plans, and support corrective actions that prevent recurring payment issues. My experience includes post-pay and prepay audits, medical coding review using ICD-10, CPT, and HCPCS, CMS guideline compliance, provider payment validation, recovery investigations, stop-loss audits, and vendor file oversight. I have helped identify significant savings through data mining and overpayment analysis, including contributions to initiatives exceeding $100M and $184M in savings. I work confidently with Power BI, SQL queries, Facets, ProClaim, Genelco, NASCO, JIRA, Navigator, Nterflow, Flexlink, and ad hoc reporting tools. I also create process documentation, train team members, streamline workflows, reduce claims inventory, and communicate findings clearly with claims, provider relations, contracting, compliance, configuration, and operations teams. I bring a detail-oriented, analytical, and collaborative approach to resolving complex healthcare payment and claims issues.