Summary
Overview
Work History
Education
Skills
Timeline
Generic

Ambrosha Hughes

Summary

Detail-oriented healthcare professional with experience in prior authorizations, reimbursement, insurance verification, and case coordination. Strong background in EMR documentation, payer communication, and denial resolution while maintaining strict HIPAA compliance. Proven ability to support timely access to care in fast-paced and remote healthcare environments.

Overview

4
4
years of professional experience
2014
2014
years of post-secondary education

Work History

Case Manager

Mercalis
Charlotte
04.2024 - Current
  • Coordinate and document client care services within EMR systems in compliance with HIPAA standards
  • Maintain accurate case records to support service continuity and coverage requirements
  • Communicate with internal teams and stakeholders regarding referrals and documentation needs
  • Conduct follow-ups and case reviews to ensure timely service delivery and compliance

Reimbursement Specialist

Cornerstone
Charlotte
12.2022 - 04.2024
  • Verified insurance eligibility, benefits, and authorization requirements prior to services
  • Submitted and tracked insurance claims and reimbursement requests through EMR/PM systems
  • Investigated denials and prepared appeals with supporting clinical and billing documentation
  • Coordinated with payers, clinicians, and internal teams to resolve authorization and billing issues
  • Ensured documentation met payer guidelines to reduce delays and payment errors

Healthcare Advocate

TTEC
Charlotte
09.2021 - 11.2022
  • Assisted patients with understanding insurance coverage, authorizations, and healthcare services
  • Supported patient intake, scheduling, and documentation to prevent authorization delays
  • Maintained accurate records and verified documentation impacting care and reimbursement

Education

South Mecklenburg High School
Charlotte, NC

Skills

  • Prior Authorizations
  • Insurance Verification
  • Reimbursement & Claims Follow-Up Appeals & Denials
  • EMR / PM Systems
  • ICD-10, CPT & J-Code Knowledge HIPAA Compliance
  • Clinical Documentation Patient Intake & Triage
  • Payer & Provider Communication

Timeline

Case Manager

Mercalis
04.2024 - Current

Reimbursement Specialist

Cornerstone
12.2022 - 04.2024

Healthcare Advocate

TTEC
09.2021 - 11.2022

South Mecklenburg High School
Ambrosha Hughes