Tiffany Wilder

Compassionate and results-driven healthcare professional with over six years of experience in member advocacy, care coordination, pharmacy support, and provider services across high-volume healthcare environments. Recognized for strong communication skills, empathy, and the ability to manage complex cases from initiation through resolution while maintaining accuracy, compliance, and exceptional service quality. Experienced in coordinating care between members, providers, pharmacies, and internal teams to support timely access to services and improve outcomes.

Skilled in CRM systems, including Salesforce, Facets, OnBase, and Microsoft Office Suite, with a strong ability to adapt quickly to new systems and workflows. Known for strong attention to detail, problem-solving ability, and maintaining composure in fast-paced, member-facing environments. Fully remote-ready and committed to delivering high-quality support with integrity and accountability.

Credentialing Specialist at Walmart Health (2025-07 – 2025-09)

Contract via Medix Staffing

• Managed end-to-end provider credentialing and re-credentialing processes for Medicare and Medicaid programs across multiple states.
• Ensured compliance with federal, state, and payer requirements while maintaining accurate provider records and documentation.
• Collaborated with internal teams and external agencies to resolve discrepancies and ensure timely onboarding and data integrity.
• Maintained audit-ready documentation with high accuracy and attention to regulatory standards.

Care Coordinator at Included Health (2024-08 – 2024-09)

Contract via Medix Staffing

• Coordinated care plans for members with chronic and complex conditions, ensuring access to appropriate services and adherence to clinical guidelines.
• Served as a liaison between members, providers, and case management teams to support authorizations, transitions of care, and ongoing treatment needs.
• Utilized care management systems to track member progress, interventions, and outcomes in real time.

Member Advocate II at L.A. Care Health Plan (2023-11 – 2024-04)

Contract via Continuum Staffing Solutions

• Provided high-volume member support as a primary liaison for advocacy groups, community organizations, and public agencies.
• Managed complex cases, escalations, and grievances with empathy, accuracy, and timely resolution.
• Documented interactions using CRM systems including Salesforce, Facets, and OnBase while ensuring regulatory compliance.
• Partnered with internal departments to identify systemic issues and improve member experience and service delivery.
• Delivered outreach and education to external partners regarding member services and healthcare resources.

Service Advisor & Credentialing Specialist at MultiPlan (2023-01 – 2023-09)

• Supported healthcare cost management processes and provider credentialing functions.
• Maintained provider data accuracy and compliance with NCQA and CMS standards.
• Assisted in resolving provider and member inquiries while improving operational efficiency and turnaround times.

Pharmacy Technician Specialist at PharmaSource (2022-01 – 2022-08)

Contract via Contemporary Staffing

• Prepared and processed medications while ensuring accuracy, safety, and compliance with pharmacy regulations.
• Assisted patients with medication guidance and collaborated with pharmacists to support optimal care delivery.

Patient Advocate Specialist at UnitedHealth Group (2019-08 – 2021-09)

• Served as primary contact for members regarding benefits, coverage, and authorization support.
• Managed escalated cases, ensuring timely resolution and strong member satisfaction.
• Coordinated care and maintained detailed documentation across all member interactions.

Sales and Marketing Consultant at Bluegreen Vacations (2018-09 – 2019-07)

• Conducted customer outreach and marketing initiatives to drive engagement and brand awareness.
• Performed market research and supported campaign development and execution.

Norwalk Community College