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Start the pasta: Bring a saucepan of lightly salted water to a boil over medium heat. Stir in macaroni and return to a boil. Cook, stirring occasionally, until tender yet firm to the bite, about 8 minutes.
While the pasta is cooking, make the fish: Heat olive oil in a large skillet over medium heat. Sprinkle tilapia on both sides with lemon juice, oregano, basil, cilantro, salt, and pepper. Place fillets into the hot skillet making sure they don't touch. Sear until golden brown on the outside and opaque and flaky on the inside, 2 to 4 minutes per side. Remove to a plate.
Finish the pasta: Drain the macaroni and return to the saucepan. Add olive oil and stir to coat. Mix in Parmesan cheese, then mix in lemon juice, garlic powder, basil, oregano, cilantro, salt, and pepper.
Divide pasta between two plates and top each with a tilapia fillet.