Tiana Harris
Lake Charles
Summary
Detail-oriented Healthcare Reimbursement Professional with expertise in claims analysis and payment integrity review. Knowledgeable in CMS regulations and No Surprises Act requirements, delivering compliant reimbursement decisions. Committed to enhancing skills for future roles in quality auditing and compliance review.
Overview
8
8
years of professional experience
Work History
Health Insurance Specialist
Provider Resources, LLC
09.2025 - Current
- Evaluate case submissions to determine whether the Federal IDR process applies, ensuring alignment with No Surprises Act eligibility rules.
- Reviewed and analyzed federal payment disputes to ensure compliance with IDRE policies and No Surprises Act requirements.
- Analyze payment offers and case documentation to determine fair, compliant outcomes between nonparticipating providers and group health plans.
- Prepared clear, defensible payment determinations based on case facts and federal regulatory guidance, facilitating fair resolutions.
- Review appeal-related documentation to verify completeness, compliance, and relevance to the dispute.
- Maintained accurate, timely case documentation in federal reporting portals to support regulatory compliance and efficient case management.
Patient Account Specialist Senior
CHRISTUS Health
01.2023 - 09.2025
- Investigated denied and underpaid claims through account analysis and prepared appeals to secure rightful payments.
- Collaborated with providers, billing teams, and insurance representatives to resolve complex billing issues.
- Reviewed insurance claims to verify reimbursement accuracy and ensure payer compliance.
- Analyzed accounts receivable reports to identify trends, facilitating timely balance resolution.
Claims Escalation Analyst / Reimbursement Specialist
CHRISTUS Health
06.2018 - 12.2022
- Collaborated with payers and internal teams to address unpaid balances, underpayments, and denials, facilitating timely resolutions.
- Identified billing discrepancies, coding issues, and compliance risks during claim reviews, enhancing overall claims accuracy.
- Resolved complex insurance accounts through thorough review of payer policies, contracts, and reimbursement guidelines, ensuring accurate reimbursement.
Education
AAS - Health Information Technology
Delgado Community College
New Orleans, LA05-2026
Skills
- Claims analysis and review
- CMS and NSA compliance
- Payment integrity management
- Appeals processing
- CPT, ICD-10-CM, and HCPCS coding
- UB-04 and EOB analysis
- Policy interpretation and documentation accuracy
- Epic and Meditech proficiency
- SSI and HIPAA compliance
- Claims platforms and clearinghouses expertise
- Excel (pivot tables, VLOOKUP)
- Audit tools utilization
Timeline
Health Insurance Specialist
Provider Resources, LLC
09.2025 - Current
Patient Account Specialist Senior
CHRISTUS Health
01.2023 - 09.2025
Claims Escalation Analyst / Reimbursement Specialist
CHRISTUS Health
06.2018 - 12.2022
AAS - Health Information Technology
Delgado Community College