Alberta Tillis
Greensburg
Summary
Results-driven Claims Audit Specialist with a proven track record at Our Lady Of The Lake Hospital, leveraging strong analytical skills and attention to detail to enhance claim accuracy. Adept at resolving discrepancies and improving workflows, while maintaining compliance with regulations and delivering exceptional customer service.
Overview
16
16
years of professional experience
Work History
Claims Audit Specialist
Our Lady Of The Lake Hospital
Baton Rouge, LA
01.2016 - Current
- Reviewed and audited insurance claims for accuracy, completeness, and compliance with company policies and procedures.
- Investigated discrepancies and resolved claim processing issues in a timely manner.
- Verified documentation, coding, and billing information to ensure proper claim adjudication.
- Analyzed claim data and identified errors, trends, and potential risk areas.
- Maintained detailed records and documentation of audit findings and corrections.
- Worked with multiple departments to improve claim accuracy and workflow efficiency.
- Processed high volumes of claims while maintaining quality and productivity standards.
- Ensured compliance with HIPAA regulations and confidentiality requirements.
- Communicated professionally with providers, clients, and internal teams regarding claim issues and resolutions.
- Applied strong analytical, mathematical, and decision-making skills to evaluate claims.
Patient Account Representative
Our Lady Of The Lake Hospital
Baton Rouge, LA
09.2013 - 01.2016
- Processed patient payments, posted transactions, and maintained accurate financial records in billing systems.
- Resolved billing discrepancies by researching accounts and coordinating with insurance companies and internal departments.
- Initiated and followed up on insurance claims to ensure timely reimbursement and account resolution.
- Communicated with patients, providers, and insurance carriers in a professional and courteous manner.
- Assisted patients with questions regarding statements, insurance coverage, copayments, and payment plans.
- Verified insurance eligibility and benefits to ensure proper billing and reduce claim delays or denials.
Medical Coder
North Oaks Medical Center
Hammond, La
04.2010 - 09.2013
- Assigned accurate medical codes (ICD-10-CM, CPT, and HCPCS) for diagnoses, procedures, and services based on provider documentation.
- Reviewed clinical documentation to ensure accuracy, completeness, and compliance with coding guidelines.
- Verified patient records, physician notes, and billing information to support correct code selection.
- Ensured coding compliance with HIPAA regulations, CMS guidelines, and payer-specific requirements.
- Used electronic health record (EHR) systems and coding software to enter and manage patient data.
- Maintained productivity and quality benchmarks while handling high-volume workloads.
- Applied knowledge of anatomy, medical terminology, and disease processes in daily coding tasks.
Education
Associate of Science -
Virginia College
Baton Rouge, LA11.2015
Skills
- Strong proficiency with Windows PC applications and computer systems
- Fast and accurate keyboarding and data entry skills
- Ability to quickly learn and adapt to new software programs and systems
- Strong research and investigative skills using multiple sources and documented guidelines
- Excellent interpersonal and customer service skills
- Strong active listening skills with attention to detail and accuracy
- Excellent verbal and written communication skills
- Strong reading comprehension and ability to interpret guidelines and procedures
- Critical thinking, analytical reasoning, and sound decision-making skills
Timeline
Claims Audit Specialist
Our Lady Of The Lake Hospital
01.2016 - Current
Patient Account Representative
Our Lady Of The Lake Hospital
09.2013 - 01.2016
Medical Coder
North Oaks Medical Center
04.2010 - 09.2013
Associate of Science -
Virginia College