Tisa Nathaniel
Woodbine,GA
Summary
Detail-oriented medical billing professional managing high-volume claims with accuracy. Consistently resolves discrepancies through effective communication, ensuring compliance with payer guidelines. Focuses on optimizing revenue cycles and enhancing financial oversight.
Overview
1
1
Certification
12
12
years of professional experience
Work History
Medical Billing Representative
USPI- United Surgical Partners International
05.2025 - Current
- Processed and finalized 1,000 to 1,400 insurance claims monthly, consistently meeting efficiency targets.
- Entered patient demographics, insurance details, service codes, and charges into billing system, ensuring accuracy to facilitate timely reimbursements.
- Extracted and verified billable services from clinical notes, EMRs, and other records.
- Collaborated with clinical and administrative staff to rectify missing documentation and coding errors.
- Adhered to HIPAA regulations and payer-specific guidelines throughout all operations.
- Reviewed and generated reports balancing charge summaries, identifying discrepancies to enhance financial oversight.
- Posted charges, payments, and adjustments meticulously to sustain accurate financial records.
- Monitored and addressed underpayments, contributing to improved revenue cycle management.
Medical Billing Representative
Surgical Care Affiliates Inc.
11.2021 - 02.2025
- Managed high-volume claims queue, submitting 120-150 claims daily with high accuracy.
- Resolved billing discrepancies through thorough account analysis and effective communication with insurers.
- Monitored changes in payer policies, adjusting billing methods to sustain revenue.
- Reviewed monthly patient aging reports, following up on overdue payments to increase collection rates.
- Maintained expertise in CPT and ICD-10 coding principles and regulations affecting billing.
- Created detailed medical implant invoices for surgeries using advanced invoicing system.
- Provided insights during departmental meetings to improve billing efficiency and revenue generation.
Patient Service Representative II
Southeast Georgia Health System
01.2015 - 11.2021
- Processed 80 to 120 insurance claims daily for submission to third-party payers.
- Analyzed claim rejections and resolved billing discrepancies efficiently.
- Acted as primary liaison with patients and third-party vendors, resolving payer issues to enhance patient experience.
- Ensured compliance with carrier guidelines through effective resolution of reimbursement concerns.
- Participated in ongoing training programs on HIPAA compliance to maintain regulatory knowledge.
- Verified insurance eligibility and coverage for patients, facilitating smooth claims processing to expedite reimbursement.
Education
Diploma - Medical Billing And Coding
Lincoln College of Technology
Marietta, GA06-2010
Diploma - Medical Assistant
Georgia Medical Institute
Marietta, GA01-2005
Skills
- Claims processing
- Insurance eligibility verification
- CPT code knowledge
- ICD-10 proficiency
- Claims management systems
- Electronic health records
- Revenue cycle management
- Revenue cycle optimization
- HIPAA compliance
Certification
- Certified Patient Account Representative
- Medical Billing Assistant
Timeline
Medical Billing Representative
USPI- United Surgical Partners International
05.2025 - Current
Medical Billing Representative
Surgical Care Affiliates Inc.
11.2021 - 02.2025
Patient Service Representative II
Southeast Georgia Health System
01.2015 - 11.2021
Diploma - Medical Billing And Coding
Lincoln College of Technology
Diploma - Medical Assistant
Georgia Medical Institute