Katrina Pauline Tibillo
Revenue Cycle Management: Missing Information & Eligibility Verification Specialist (Auditor)
San Pablo City
Summary
Dynamic Bachelor of Science in Nursing graduate with nearly four years of progressive experience in laboratory operations, revenue cycle management, and insurance eligibility processes. Dedicated to supporting US-based hospitals, providers, insurance companies, and specialty clinics. Proven leader in team dynamics, auditing, and process improvement within fast-paced, high-volume environments. Expertise includes insurance verification, eligibility and benefits checks, prior authorizations, and billing processes (including AMD), with a strong focus on data accuracy, regulatory compliance, and proficiency in healthcare systems such as EHR/EMR. Recognized for exceptional attention to detail and high-quality output, consistently identifying discrepancies that impact claims and revenue.
Overview
3
3
years of professional experience
Work History
Intake Coordinator (Training Ground)
One Suite Global Solutions (Client: Universal Medical Alliance)
01.2023 - 02.2023
- Scheduled patient appointments and managed intake processes.
- Ensured accurate patient registration and data entry.
- Verified patient information and supported care coordination.
Routing Coordinator (Dispatcher/Route Manager)
Rocky Mountain Laboratories (via One Suite Global Solutions)
02.2023 - 2023
- Managed and optimized courier routes for specimen pickups.
- Ensured efficient dispatching and timely service delivery.
- Coordinated logistics and maintained accurate tracking records.
Lead Coordinator – Order Entry and Results Team Lead
Rocky Mountain Laboratories (via One Suite Global Solutions)
03.2023 - 10.2024
- Led daily operations of both Order Entry and Results Teams with 10 agents, each handling 80 orders per day (800+ total daily volume).
- Ensured 95–98% accuracy rate across order processing, minimizing rework and billing issues.
- Oversaw end-to-end order processing, including verification of test requests, ICD-10 codes, and accurate system documentation.
- Facilitated communication between patients and healthcare providers with professionalism and empathy.
- Managed provider schedules and patient records to optimize workflow efficiency.
- Verified insurance information and ensured complete and compliant patient data.
- Utilized EMR/EHR systems to upload and manage critical documentation.
- Trained and mentored new employees and ensured adherence to SOPs.
- Improved operational efficiency by reducing errors, increasing processing speed, and minimizing escalations.
- Handled escalations, complaints, and complex operational issues.
Accession Auditor Supervisor and Results Team Lead
Rocky Mountain Laboratories
04.2024 - 10.2024
- Supervised two teams (10 agents total) handling accession auditing and results processing.
- Oversaw daily auditing volume of approximately 800+ accessions/orders, ensuring adherence to quality and compliance standards.
- Maintained 95–98% accuracy rate across auditing processes, significantly reducing duplicate records, billing errors, and data inconsistencies.
- Conducted detailed audits focusing on duplicate order processes, duplicate patient records, accession duplication, and other critical discrepancies.
- Verified key data points including collection dates, ICD-10 codes, and test orders to ensure billing accuracy and eligibility.
- Implemented process improvements that resulted in faster turnaround time, reduced errors, and fewer escalations.
- Led the Results Team in reviewing, validating, and uploading laboratory results into EHR/EMR systems with high precision.
- Managed escalations, ensuring timely resolution of complex data inconsistencies while maintaining service quality.
Missing Information & Eligibility Lead
Rocky Mountain Laboratories
10.2024 - 11.2025
- Led a team of 10 agents, overseeing insurance verification and resolution of missing or incomplete patient information impacting claims processing.
- Managed daily operations handling approximately 800+ eligibility verifications per day (team total) with a per-agent quota of 80.
- Maintained team accuracy rates of 95–98%, ensuring high-quality outputs and compliance with payer requirements.
- Reduced operational errors and escalations by implementing process improvements and quality checks.
- Directed end-to-end eligibility workflows, ensuring accurate validation of insurance coverage, benefits, and policy requirements.
- Managed escalations involving complex billing and eligibility issues, providing expert-level troubleshooting and resolution.
- Monitored KPIs, improved turnaround efficiency, and ensured consistent productivity across the team.
- Played a critical role in revenue protection by minimizing errors that could lead to delayed or denied claims.
Revenue Cycle Management: Missing Information & Eligibility Verification Specialist (Auditor)
Rocky Mountain Laboratories
12.2025 - Current
- Perform comprehensive audits on eligibility verification and missing information workflows, ensuring strict adherence to payer guidelines and internal quality standards.
- Conduct in-depth reviews of patient demographics, insurance coverage, policy status, and supporting documentation to proactively prevent claim denials and revenue leakage.
- Maintain an average audit accuracy rate of 95–98%, identifying discrepancies that directly impact billing outcomes.
- Analyze trends in errors and discrepancies, providing actionable insights that contributed to reduced error rates and fewer escalations.
- Collaborate cross-functionally with billing, operations, and clinical teams to resolve complex issues impacting claims processing.
- Step in to support eligibility verification operations during peak volumes, helping process high-volume workloads efficiently while maintaining quality standards.
Education
Bachelor of Science - Nursing
Laguna College
San Pablo City, Laguna11-2022
Senior High School - STEM Strand
Liceo de San Pablo
San Pablo, Laguna01-2018
Junior High School - undefined
Liceo de San Pablo
San Pablo, Laguna01-2016
Skills
- Revenue Cycle Management (RCM)
- Insurance Verification & Eligibility
- Prior Authorization Processing
- Medical Billing (AMD System)
- ICD-10 Coding Validation
- Auditing & Quality Assurance
PROFILE
- Strong leadership and team management capabilities
- Excellent interpersonal and communication skills
- Highly adaptable in fast-paced and changing environments
- Detail-oriented with a strong focus on accuracy and compliance
- Quick learner with the ability to master new systems and processes
- Committed to maintaining professional and ethical healthcare standards
ADDITIONAL INFORMATION
- Certified in Basic Life Support (BLS) and First Aid (2022)
- Completed hospital-based training (Laguna Medical Center)
- Strong background in healthcare administration and operations
Timeline
Revenue Cycle Management: Missing Information & Eligibility Verification Specialist (Auditor)
Rocky Mountain Laboratories
12.2025 - Current
Missing Information & Eligibility Lead
Rocky Mountain Laboratories
10.2024 - 11.2025
Accession Auditor Supervisor and Results Team Lead
Rocky Mountain Laboratories
04.2024 - 10.2024
Lead Coordinator – Order Entry and Results Team Lead
Rocky Mountain Laboratories (via One Suite Global Solutions)
03.2023 - 10.2024
Routing Coordinator (Dispatcher/Route Manager)
Rocky Mountain Laboratories (via One Suite Global Solutions)
02.2023 - 2023
Intake Coordinator (Training Ground)
One Suite Global Solutions (Client: Universal Medical Alliance)
01.2023 - 02.2023
Senior High School - STEM Strand
Liceo de San Pablo
Junior High School - undefined
Liceo de San Pablo
Bachelor of Science - Nursing
Laguna College