Tieisha Jones
Fort Worth,TX
Summary
Healthcare revenue cycle professional with deep experience in medical billing, A/R follow-up, insurance collections, and denial resolution across Medicare, Medicaid, and commercial payers. Manages high-volume queues, overturns medical necessity and technical denials, and maintains a 95%+ quality assurance score while working closely with coding teams and payer portals.
Overview
19
19
years of professional experience
Work History
Medical Collection Specialist
SCP Health
Dallas, TX
11.2018 - 03.2026
- Managed complex A/R portfolios for Medicare, Medicaid, and commercial payers to reduce aging claims and achieve reimbursement targets.
- Investigated root causes of claim non-payment (coding/billing errors, documentation gaps) and executed appeal strategies to overturn medical necessity and technical denials.
- Applied specialized coding knowledge for emergency department and hospital medicine services, collaborating with coding teams to rectify discrepancies and prevent recurring denials.
- Monitored payer research and behavior trends, providing weekly feedback to management on facility adjudication concerns to inform process improvements.
- Achieved consistent adherence to high-volume productivity standards while securing a 95%+ Quality Assurance audit score, ensuring quality in claims processing.
- Utilized OnBase, Centricity, and payer portals to efficiently research accounts, verify patient liability, and validate credit balances/recoupment demands, enhancing accuracy in collections.
Patient Financial Service Associate IV
CHRISTUS Health
Irving, TX
08.2016 - 10.2018
- Managed insurance collection queues for technical denials, rejections, and at-risk Medicaid/government claims, ensuring full regulatory compliance.
- Analyzed government-mandated filing requirements and billing guidelines to facilitate timely appeals, adjustments, and reconsiderations.
- Resolved account discrepancies, including underpayments, overpayments, and credit balances, while addressing recurring billing trends.
- Documented account actions accurately within patient accounting host systems and escalated emerging financial risks to leadership.
Collections Specialist
National Patient Account Services (NPAS)
Bedford, TX
08.2011 - 07.2016
- Conducted account research and payer follow-up with Medicare, Medicaid, and Commercial HMO plans, successfully resolving delinquent account balances.
- Managed over 90 inbound and outbound calls daily in fast-paced environment, delivering exceptional customer service while ensuring HIPAA compliance.
- Managed patient account collections for National Patient Account Services healthcare billing workflows.
- Contacted patients to discuss balances, payment options, and account resolution.
- Reviewed delinquent accounts and updated notes in patient account systems.
Enrollment Analyst
CGI Technologies
Fort Worth, TX
02.2008 - 06.2011
- Resolved enrollment discrepancies for Medicare Part D Prescription Plans, ensuring compliance with CMS turnaround times.
- Processed enrollment applications using CGI client systems and benefit workflows.
- Reviewed eligibility records for completeness and accuracy.
- Resolved enrollment discrepancies with members and internal teams.
Customer Service Representative
CGI Technologies
Fort Worth, TX
01.2007 - 01.2008
- Educated beneficiaries on Medicare Part D plan features, eligibility, and EOBs, resulting in increased understanding and informed enrollment decisions.
- Resolved client inquiries using CGI Technologies service desk procedures.
- Logged cases in CGI Technologies ticketing systems with accurate details.
- Escalated complex issues to CGI Technologies support teams.
Education
High School Diploma -
O.D Wyatt High School
Fort Worth, TXSkills
- Revenue cycle management
- Payer regulatory expertise
- Medical collections
- Claims denial appeals
- Coding billing knowledge
- Technical proficiency
- Payer portal research
- Financial Analysis
Timeline
Medical Collection Specialist
SCP Health
11.2018 - 03.2026
Patient Financial Service Associate IV
CHRISTUS Health
08.2016 - 10.2018
Collections Specialist
National Patient Account Services (NPAS)
08.2011 - 07.2016
Enrollment Analyst
CGI Technologies
02.2008 - 06.2011
Customer Service Representative
CGI Technologies
01.2007 - 01.2008
High School Diploma -
O.D Wyatt High School