Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Tisha Capps

Stuart,FL

Summary

Strong working knowledge of medical billing revenue cycles and accounts receivable, Experienced billing specialist, Provider credentialing, HIPAA Regulations, Able to multi-task prioritize & organize multiple projects and day-to-day tasks, Comfortable leading presentations, Experienced with multi-specialties practices, Experienced with Medicare, Medicaid, Workers Compensation billing protocols, Strong computer skills with advanced proficiency in word processing, spreadsheet, email, and EMR apps. Comprehensive knowledge of ICD-10, CPT & HCPCS coding. Logical Medical Biller proudly offers many years of experience reviewing accounts and maintaining patient records. Driven professional with background in medical terminology and coding. Recognized task prioritization expertise in fast-paced environments.

Overview

21
21
years of professional experience

Work History

Medical Billing Specialist

ITX Companies
Kingsport, TN
01.2022 - Current
  • Company Overview: Revenue Cycle Management.
  • Responsible for working on denied claims (front-end rejections and insurance denials).
  • Payers worked: Cigna, Medicare, Medicaid, including Medicare HMO plans, Workers' Compensation, Cigna, United Healthcare, private state programs, BCBS, private commercial payers, Veterans Affairs, hospice, and MVA.
  • Duties include verifying that the correct insurance plan/payer was filed, obtaining authorizations for billing, contacting adjusters for injury details and billing details, correcting and updating modifiers for multiple provider/procedure charges, filing appeals, reconsiderations, and disputes when applicable for claim resolution, and managing accounts to have been paid and/or worked in under 90 days.
  • Maintained timely and accurate charge submission through electronic charge capture, including billing, and account receivables (BAR) system and clearing house.
  • Performed accurate and fully compliant monthly closing processes, accruals and journal entries.
  • Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
  • Provider billing for TN, GA, OH, FL, MO, AR
  • Adhered to HIPAA regulations when handling confidential patient information.

Catering Coordinator & Bartender

Tasteful Gatherings
Cleveland, TN
03.2021 - 12.2024
  • Coordinated with vendors to ensure timely delivery of food, beverages, and other supplies.
  • Consistently maintained high levels of cleanliness, organization, storage and sanitation of food and beverage products to ensure quality.
  • Promoted safe working conditions by monitoring safety procedures and equipment.
  • Delegated work to staff, setting priorities and goals.
  • Supervised staff during events to ensure proper execution of duties according to established procedures.
  • Checked with guests to get feedback on food served, resolve issues, bring additional items and refill beverages.
  • Executed scheduling, logistics, and follow-ups with event staff.
  • Resolved any customer complaints in a professional manner.

Head Bartender

Ooltewah Country Club
Ooltewah, TN
02.2021 - 01.2022
  • Used POS system to input orders, create checks and issue receipts.
  • Worked closely with kitchen staff to ensure proper food-drink pairings were available on menus for customers' satisfaction.
  • Ensured compliance with health and safety regulations at all times.
  • Greeted guests with friendliness and professionalism.
  • Prepared new garnishes, juices and other perishables daily.
  • Arranged bottles and glasses behind bar to make attractive displays.
  • Provided exceptional customer service to guests in accordance with established standards.
  • Coordinated promotional activities such as happy hour specials or themed nights aimed at increasing foot traffic during slow periods.

Bartender and Server

Cape Coral Golf Resort
Cape Coral, FL
05.2017 - 05.2019
  • Planned and coordinated special events to boost customer numbers and profits.
  • Neatly sliced and pitted fruit for garnishing drinks.
  • Greeted guests with friendliness and professionalism.
  • Effectively multitasked within fast-paced environment.
  • Remained calm and poised during busy periods, promoting great customer service to guests.
  • Kept track of bar tabs and transferred open tabs to dining area for wait staff.
  • Maintained knowledge of bar and menu options to prepare drinks and make food recommendations.
  • Operated cash register and Point of Sale (POS) system for transactions and made proper change for cash transactions.
  • Performed opening and closing duties including restocking supplies.
  • Measured and mixed house ingredients to prepare both custom and menu drink orders.

Medical Billing Specialist

Physician Practice Resources
01.2013 - 01.2014
  • Company Overview: Revenue Cycle Management
  • Billing of claims and worked accounts receivables for Orthopedic Surgeons, physical therapist, and chiropractors
  • All electronic claims sent thru EDI
  • Worked reports daily for confirmation of accepted claims and made corrections to rejected / invalid claims
  • Verified corrections were applied to patients' accounts
  • Accounts Receivable / Aging Reports worked monthly
  • Worker Comp Claims- Responsible for retrieving claim & date of injury of injured employee
  • Maintained contact with claim adjuster or employer for all authorizations for visits
  • Mailed all claims and medical records to insurance
  • Worked closely with adjusters to make sure all authorized visits paid at contracted rate
  • Payments and adjustments posted from electronic and paper remits
  • All denials worked based on reason
  • Corrections made to claims accordingly and corrected claims submitted
  • Appeals worked and submitted based on insurance appeal process and requirements
  • All CPT codes for surgeries, fracture care and any other “global” procedure codes were checked prior to claim submission
  • Checked Medicare LCD’s and CCI edits
  • Very familiar with modifiers (unbundling, post op, pre op decisions for surgery, therapy, ABN, etc.) Also with Medicare required modifiers, CPT codes, therapy caps, etc
  • Revenue Cycle Management

Front Desk / Medical Billing

Dr. Subroto Kundu, MD
01.2010 - 01.2011
  • Company Overview: Neurology Office
  • Responsible for all electronic claims submission (Gateway)
  • Electronic and manual remit and cash posting
  • Procedure pre-certification, referrals, authorizations
  • Handle patient account questions, Insurance follow-up, patient collections
  • Responsible for keeping insurance updates and reporting changes to management
  • Misc
  • Includes: scheduling appointments, pulling/filing charts, backing up front desk
  • Neurology Office

Director of Client Coordination

E-LifeCare TRM Solutions
01.2007 - 01.2009
  • Company Overview: Revenue Cycle Management
  • Conducted Diagnostic Billing Audits for prospect clients by identifying billing problems
  • Developed working relationships with administration and faculty of clients
  • Conducted hiring fairs
  • Developed and trained new hires on medical software and accounts receivables processes
  • Worked as a liaison between corporate office, billing headquarters, and providers
  • Performed month-end close duties
  • Revenue Cycle Management

Front Desk / Charge Posting

Voytik Center for Orthopedic Care
01.2004 - 01.2006
  • Company Overview: Orthopedic Surgeons
  • Electronic and manual claims submission
  • Electronic and manual remit and cash posting
  • Procedure pre-certification, referrals, authorizations
  • Handle patient account questions
  • Insurance follow-up, patient collections
  • Patient financial agreements
  • Coding charges
  • Front desk duties: checking in patients, updating information in chart and system, phones, scheduling appointments
  • Orthopedic Surgeons

Education

Healthcare Administration -

Cleveland State Community College

Skills

Software Applications

  • Misys Tiger, QRS Paradigm, Advanced MD, Medisoft, Micro MD, Next Gen, EClinicalWorks, Phicure, Availity, EPIC, Imagine, Ethin, Emdeon, OnBase, Athena - EDI, Commerical Payer Portals
  • Bill payment
  • Quality-oriented team player
  • Files and records management
  • Medicare and medicaid process
  • Patient billing
  • Insurance verification
  • ICD-10 proficiency
  • Accounts payable
  • CPT knowledge
  • HIPAA compliance
  • Denial management
  • Collections management
  • Claim submission
  • Payment posting
  • Claims review

References

  • Danny Barnett, Barnett & Associates (770) 823-2610
  • Dee Johnston, Tasteful Gatherings (423) 337-1887
  • Misti Cross, Tasteful Gatherings (423) 414-6140

Timeline

Medical Billing Specialist

ITX Companies
01.2022 - Current

Catering Coordinator & Bartender

Tasteful Gatherings
03.2021 - 12.2024

Head Bartender

Ooltewah Country Club
02.2021 - 01.2022

Bartender and Server

Cape Coral Golf Resort
05.2017 - 05.2019

Medical Billing Specialist

Physician Practice Resources
01.2013 - 01.2014

Front Desk / Medical Billing

Dr. Subroto Kundu, MD
01.2010 - 01.2011

Director of Client Coordination

E-LifeCare TRM Solutions
01.2007 - 01.2009

Front Desk / Charge Posting

Voytik Center for Orthopedic Care
01.2004 - 01.2006

Healthcare Administration -

Cleveland State Community College

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Tisha Capps