Tabitha Khadse

LinkedIn | Remote

• Served as a subject matter expert evaluating AI-generated healthcare administrative outputs related to insurance eligibility, benefits coordination, and enrollment workflows.
• Extracted and validated structured member and plan information from unstructured insurance emails and attachments, applying payer and provider administrative rules to prevent eligibility and enrollment errors.
• Performed manual and tool-based PII and PHI redaction in HIPAA-aligned environments to ensure sensitive data was not exposed during AI evaluation or feedback cycles.
• Applied and refined rubric-based evaluation criteria to assess AI output accuracy, completeness, and rule adherence, including identifying missing alpha prefixes and invalid identifier lengths.
• Defined acceptance criteria for valid extractions and administrative rule compliance to ensure consistent identification of errors and rule violations.
• Drafted and quality-checked outbound enrollment communications to ensure clarity, compliance, and correct use of member and plan information prior to delivery.
• Documented recurring error patterns and provided structured, actionable feedback to improve AI reliability, compliance, and consistency across healthcare operations use cases.

Providence Healthcare Management | Remote

• Managed end-to-end medical billing processes including charge entry, claim submission, payment posting, denial resolution, and account reconciliation.
• Verified patient eligibility and benefits across multiple payer systems, ensuring correct coverage status, effective dates, and identifier formats.
• Interpreted payer-specific billing and enrollment rules to prevent rejections and reduce claim denials.
• Handled PHI and financial data in strict compliance with HIPAA and internal security standards.
• Collaborated with providers, clearinghouses, and insurance representatives to resolve discrepancies in member data and coverage information.
• Improved billing accuracy and reduced rework by identifying recurring data quality issues in patient and insurance records.

Richter Healthcare Consultants | Remote

• Verified eligibility and prior authorizations for managed Medicare and commercial insurance claims.
• Submitted claims through clearinghouses and payer portals, reconciling rejections and discrepancies.
• Standardized denial management workflows and prepared appeals with supporting documentation.
• Conducted AR reviews (30/60/90 days) to reduce outstanding balances.
• Ensured accurate coordination of benefits (COB) processing for secondary claims.
• Reviewed EOB/ERA remittances to identify payer-specific issues and appeal opportunities.

MSN Healthcare Solutions | United States

• Managed radiology billing for diagnostic and interventional services including X-ray, CT, MRI, ultrasound, and nuclear medicine.
• Prepared claims using UB-04 and CMS-1500 forms with CPT modifiers in compliance with NCCI edits and MPPR rules.
• Verified medical necessity (LCD/NCD) and payer-specific requirements prior to submission.
• Resolved rejections and denials and documented account activity to maintain accurate AR balances.
• Reviewed EOBs/ERAs to verify payer adjustments and ensure reconciliation accuracy.
• Coordinated with coding and radiology teams to ensure proper charge capture and claim integrity.