MIESHA AUGUSTINE
Atlanta,GA
Summary
A versatile healthcare operations and Epic systems professional with over 10 years of experience working inside healthcare organizations to manage patient billing, revenue cycle management, and optimize workflows using Epic systems. Proven track record in managing financial processes, ensuring compliance, and improving operational efficiency across hospitals and healthcare organizations. Skilled in collaborating with cross-functional teams, communicating effectively with patients, providers, and payors, and leading initiatives that streamline processes and enhance patient experience. Adept at analyzing technical solutions, implementing system enhancements, and aligning healthcare technology with organizational goals.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Pre Certification Specialist
WELLSTAR HEALTHCARE SYSTEM
08.2021 - Current
- Entered and maintained authorization details accurately in Epic EHR system, ensuring compliance and audit readiness.
- Obtained prior authorizations and pre-certifications from insurance payers for outpatient procedures, diagnostics, and services.
- Reviewed and applied payer guidelines, CPT and ICD-10 codes, and medical necessity requirements to ensure timely approvals.
- Coordinated with physicians, clinics, schedulers, and insurance carriers to resolve authorization issues and prevent delays in care.
- Communicated authorization status and next steps to patients and providers, including appeals for denied services.
- Supported revenue cycle operations by reducing claim denials and improving authorization turnaround times.
Customer Service Patient Liability Representative I
Piedmont Healthcare Corporate
10.2017 - 11.2020
- Utilized Epic (EHR) to access, review, and update patient accounts, ensuring accurate documentation and billing workflows.
- Delivered high-quality customer service by assisting patients with billing inquiries, insurance questions, and payment options.
- Ensured accurate billing for services provided by verifying insurance details, charges, and supporting documentation.
- Supported efficient resolution of billing and insurance issues through timely follow-up with payers, patients, and internal teams.
- Educated and guided patients in understanding and managing their healthcare payments, including payment plans and financial assistance options.
- Collaborated with revenue cycle, clinical, and authorization teams to resolve discrepancies and improve billing accuracy and turnaround times.
Revenue Cycle Representative III
Ochsner Health System
01.2015 - 06.2017
- Utilized Epic EHR to document, track, and manage prior authorization requests, payer determinations, and clinical updates to ensure accurate records and timely approvals.
- Managed end-to-end prior authorization and pre-certification processes for inpatient and outpatient services across commercial and government payers.
- Communicated with insurance carriers via phone, portals, and fax to verify benefits, medical necessity, and coverage requirements.
- Collaborated closely with providers, nurses, and case managers to obtain required clinical documentation and resolve authorization issues.
- Monitored authorization statuses, followed up on pending cases, and ensured approvals were secured before scheduled services.
- Supported denials and appeals, including preparation of documentation and coordination of peer-to-peer reviews when required.
- Served as a resource for complex or high-acuity authorizations, ensuring compliance with payer policies and turnaround timelines.
Registrar
Tulane University Hospital and Clinic
10.2009 - 03.2010
- Registering new patients, verify insurance, securing authorizations and advising patients of their financial responsibility.
- Completely and accurately document communication with payers, patients, and the treatment team.
- Collects and accurately enters confidential information ensuring the highest level of confidentiality in all areas.
- Assist in the training of new employees in department procedure, protocols, and administrative task.
Customer Service Representative
American Red Cross/ FEMA & Housing Authority of Atlanta
09.2005 - 02.2007
- Demonstrated a strong record of accomplishment for working collaboratively on cross-functional and cross-culture teams.
- Communicated with customers about services available and assesses customer needs.
- Handled all customer questions/concerns in relation to assistance process and status via phone or email in a timely manner.
Education
Bachelor of Science - Business Management
Western Governors University
Salt Lake City, UT12-2025
Certified Dialysis Technician -
Blue Cliff College
06.2010
High school diploma - New Orleans Center for Science & Math
Warren Easton High School
05.2002
Skills
- Epic Systems
- Healthcare Management
- Communication Skills
- Microsoft Office
- Customer Service
- Administrative Skills
- Bookkeeping
- Interpersonal Skills
- Problem-solving and analytical skills
Certification
- Certified Healthcare Financial Professional – Business of Health Care
- Certified Healthcare Financial Professional – Operational Excellence
- Certified Revenue Cycle Representative (CRCR)
Oracle Cloud Infrastructure 2025 Certified Generative AI Professional - Oracle Cloud Infrastructure 2025 Certified AI Foundations Associate
- Oracle Cloud Infrastructure 2025 Certified Foundations Associate
- Oracle Data Platform 2025 Certified Foundations Associate
STRENGTHS
- Ability to plan, organize and manage multiple projects and set priorities.
- Ability to Manage patient dialysis treatment including inserting needles, recording vital signs, documenting medical information.
- Exceptional problem-solving skills.
- Practice patience to keep the conversation on track, remain personable and provide a positive experience to clients.
- Can work within an ambiguous and fast-moving environment.
- Implementing quality management and regulatory compliance strategies.
- Maintain quality control/satisfaction records, constantly seeking new ways to improve customer service.
Timeline
Pre Certification Specialist
WELLSTAR HEALTHCARE SYSTEM
08.2021 - Current
Customer Service Patient Liability Representative I
Piedmont Healthcare Corporate
10.2017 - 11.2020
Revenue Cycle Representative III
Ochsner Health System
01.2015 - 06.2017
Registrar
Tulane University Hospital and Clinic
10.2009 - 03.2010
Customer Service Representative
American Red Cross/ FEMA & Housing Authority of Atlanta
09.2005 - 02.2007
High school diploma - New Orleans Center for Science & Math
Warren Easton High School
Bachelor of Science - Business Management
Western Governors University
Certified Dialysis Technician -
Blue Cliff College