About Tamara Riddle View Credentials →

A different kind of healthcare navigator.

Independent and On Your Side, OnlyAs a private-pay practice, we work alongside hospitals, providers, insurers, attorneys, and veterans benefits programs to meet your needs, while representing only you and your family, privately and independently. We never represent the insurance companies or the hospitals.

The Care Side

More than 30 years across the full continuum of care.

  • USAF nursing and military medicine
  • Hospital, surgical, and oncology provider care
  • Home health, hospice, and palliative care
  • Rehabilitation and skilled nursing management
  • Disability case management and return‑to‑work
  • Workers' compensation and personal injury medical management

The Payer and Review Side

Built and executively led the Utilization & Care Management departments, directing nurses, patient advocates, and MD peer reviewers. Experienced in healthcare navigation and patient advocacy, healthcare negotiations and care arrangements that save patients money, litigation support, legal settlements, payment integrity, healthcare compliance, and claims determinations and appeals consulting.

  • Appeals and denial management
  • Litigation support: case reviews, depositions, and hearings
  • Hospital and provider billing fraud reviews
  • Medical records review for disability, medical, and care planning
  • State and federal regulatory compliance for care navigation and financial assistance
  • Payment integrityEnsuring every claim is billed, coded, and paid correctly, so patients are never billed more than they owe.
    • Coding and documentation audits
    • Claims and charge reconciliation
    • Underpayment and overpayment identification
    • Fraud, waste, and abuse prevention
    • Reimbursement review against payer and regulatory rules
Tamara Riddle, founder of Riddle Care Navigation & Financial Advocacy
Tamara Riddle Founder · Former Vice President of Care Management and Patient Advocacy
30+Years across the healthcare continuum

Our Commitment to You

Every recommendation we make is guided by one standard: what is best for you. We work independently, with no ties to insurers, hospitals, or facilities, so our focus stays on protecting your finances, reducing unnecessary costs, saving time with care coordination and a clear understanding of billing, keeping you, your family, and your attorney updated along the way, and guiding you to the right care at every step.

Both Sides of the Table

I've managed complex care and consulted on the claims.

That rare combination is why families and attorneys trust me to get things resolved.

The Care Side

Where Patients Receive Care

  • United States Air Force Nursing and Military Medicine, Air Flight Tactical Command
  • Hospital care, including Seattle Children's Hospital and Lovelace Health System
  • Surgical and oncology provider care
  • Home health, hospice, and palliative care
  • Rehabilitation and skilled nursing management
  • Disability case management and return-to-work programs
  • Workers' compensation and personal injury medical management
  • Specialty pharmacy, Helix Pharmacy Group

The Payer and Review Side

Where Coverage Is Decided

  • As Vice President, built and led the Utilization & Care Management and Patient Advocacy departments
  • Directed appeals handling and physician (MD) peer reviews
  • Conducted medical reviews for disability claims and legal appeals
  • Litigation support: legal case reviews, depositions, and hearings
  • Hospital and provider billing fraud reviews
  • Medical records review for disability, medical, and care planning
  • Legal settlement analysis
  • Compliance consultation

"When your family is facing a denied claim, you need someone who knows the system from the inside. I understand how complex care navigation and transfers work, how insurers evaluate claims, how denials are issued, and how appeals are decided, because I led the teams responsible for those decisions."

Professional Experience

Leadership built over three decades.

22 Years · National Health Insurance Carrier

Executive Leadership

Case Manager → Assistant Vice President → Vice President

  • Former Vice President of Care Management and Patient Advocacy
  • Built and led the Utilization & Care Management Department, overseeing nurses, physicians, and clinical staff
  • Directed appeals, physician peer review, billing audits, claims integrity, and fraud, waste, and abuse detection
  • Oversaw provider contracting, financial performance, and LEAN operations restructuring

Compliance and Regulatory

Compliance Leadership

  • CMS
  • NCQA
  • HIPAA
  • URAC
  • DOI
  • ERISA
  • Served as Compliance Officer across all regulatory areas: CMS, NCQA, HIPAA, URAC, state Departments of Insurance, and ERISA
  • Expertise in audit readiness, CAPA and root-cause analysis, value-based and risk-sharing models, and reimbursement strategy

Education and Credentials

The education and credentials behind the advocacy.

Education

  • BS, Healthcare ManagementBellevue University
  • AAS, HealthcareCommunity College of the Air Force

Executive Education

  • Executive Leadership for Healthcare ProfessionalsCornell University
  • Negotiations MasteryHarvard Business School
  • AI for Leadership and AI ComplianceUT Austin, McCombs School of Business

Certifications and Service

  • Certified in Healthcare Compliance (CHC)Compliance Certification Board
  • Contributor, Complete Healthcare Compliance ManualHealth Care Compliance Association (HCCA)
  • United States Air Force VeteranNursing and Military Medicine
Proud Member of NAHAC, National Association of Healthcare Advocacy

Proud member of the National Association of Healthcare Advocacy Consultants (NAHAC)

How We Help

Common requests we handle for you.

Select any request to see exactly how we handle it, step by step.

01

Hospital and Care

Hospital stays, transitions, and doctors working together.

03

Who We Support

Individuals, families near and far, and the attorneys who serve them.

Ready to stop navigating alone?

The first 30 minutes are free. We'll assess your situation, explain your options, and give you a plan, even if you decide not to work with us.

Schedule Your Free Consultation