TYLISHON SMALLS
Wendell,NC
Summary
Accomplished healthcare operations leader with 13 years of experience focused on optimizing medical practice efficiency and revenue cycle management. Strong ability to lead cross-functional teams to drive revenue enhancements and improve patient satisfaction metrics. Track record of managing large portfolios and delivering substantial operational performance improvements and positive patient outcomes.
Overview
1
1
Certification
2027
2027
years of professional experience
Work History
Patient Access/Healthcare Operations
CenterWell
2025 - Current
- Serve as a Center Utilization Champion supporting value-based care initiatives designed to improve patient outcomes and reduce unnecessary ER utilization and hospital admissions.
- Apply utilization management principles to identify opportunities for early intervention, patient education, and appropriate care navigation.
- Collaborate with providers, nurses, care teams, and leadership to support high-risk Medicare patients and address barriers impacting health outcomes.
- Lead daily morning huddles reviewing patient needs, operational priorities, quality measures, and care opportunities.
- Support care gap closure initiatives focused on preventive care, chronic condition management, and improved patient engagement.
- Partners with interdisciplinary teams to enhance care coordination and strengthen transitions of care.
- Utilize Athenahealth EMR systems to support accurate documentation, patient workflows, and operational efficiency.
- Promote a patient-first culture by resolving concerns, improving access to care, and creating positive patient experiences.
- Assist with workflow improvements that support practice performance, quality metrics, and organizational goals.
- Coordinate patient scheduling to ensure efficient appointment management. Managed outbound and inbound calls to address patient inquiries promptly. Facilitated referral coordination to streamline patient care processes.
Business Analyst
Altera Digital Health (Allscripts)
01.2018 - 01.2022
- Led workflow improvement initiatives that enhanced billing accuracy, revenue capture, and operational efficiency.
- Conducted operational and financial analyses to enhance healthcare billing systems, optimize reimbursements, and improve revenue cycle performance.
- Functioned as Subject Matter Expert (SME) for billing conversions, healthcare system implementations, data validation, and operational readiness initiatives.
- Partnered with cross-functional teams to resolve complex billing issues while improving customer satisfaction and organizational performance.
- Developed training materials and workflow documentation to ensure regulatory compliance and facilitate employee development.
FP&A Data Operations Analyst
Altera Digital Health
01.2013 - 01.2018
- Managed financial reporting and operational analytics supporting acute care and ambulatory healthcare clients generating more than $51 million in monthly revenue.
- Executed revenue forecasting, bad debt analysis, financial variance reporting, reimbursement analysis, and strategic financial planning to inform executive decision-making.
- Collaborated with revenue cycle executives to optimize reimbursement performance, improve workflows, and strengthen financial outcomes.
- Led monthly executive business reviews with healthcare leadership to analyze financial performance, reimbursement trends, operational improvements, and strategic initiatives.
- Partnered with revenue cycle executives to optimize reimbursement performance and enhance workflows for better financial outcomes.
Workers’ Compensation Claims Adjuster II (ME)
MEMIC
01.2022 - 2024
- Managed complex lost-time workers’ compensation claims state of Maine involving medical treatment, Loss Time indemnity benefits, disability management, and return-to-work planning.
- Communicated with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed.
- Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
- Evaluated claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
- Collaborated with medical providers to obtain necessary documentation for accurate claim assessments.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Directed claims negotiations within allowable limit of $Amount and supported successful litigations for advanced issues.
- Directed and coordinated various investigations conducted by field investigation team.
Education
Bachelor of Science - Public Health Administration
Southern New Hampshire University
Manchester, NHSkills
Epic and Athena EMR/EHR systems
Quality metrics
Healthcare operations
Utilization management
Salesforce management
Team leadership
Revenue cycle solutions
Practice management
Claims management
Certification
- Lean Six Sigma Green Belt
- Workers’ Compensation Professional (AMCOMP)
- Red Cross Basic Life Support (BLS)
- NC State Notary
Timeline
Workers’ Compensation Claims Adjuster II (ME)
MEMIC
01.2022 - 2024
Business Analyst
Altera Digital Health (Allscripts)
01.2018 - 01.2022
FP&A Data Operations Analyst
Altera Digital Health
01.2013 - 01.2018
Patient Access/Healthcare Operations
CenterWell
2025 - Current
Bachelor of Science - Public Health Administration
Southern New Hampshire University