Ashawnti Myers
Columbia,SC
Summary
Experienced Care Navigator with 14 years in healthcare, specializing in patient advocacy, claims resolution, and care coordination. Expertise includes insurance benefits analysis, HIPAA compliance, and clinical collaboration to remove care barriers and enhance member satisfaction. Focused on streamlining appointment coordination and clearly communicating benefits to ensure timely access to care.
Overview
15
15
years of professional experience
Work History
Care Navigator
Rightway Healthcare
11.2023 - Current
- Liaised among members, providers, and insurance carriers to resolve care barriers and expedite authorizations.
- Partnered with clinical teams and external providers to streamline referral workflows, improving appointment continuity and care coordination.
- Scheduled appointments and coordinated with clinical teams to ensure timely care and follow-through on patient needs.
- Supported Rightway members through benefits, coverage, and care navigation questions.
- Reviewed claims, billing, and prior authorization details with members.
Claims Specialist
Express Scripts Pharmacy
06.2020 - 06.2023
- Processed insurance claims accurately, resolving high-volume cases and reducing claim backlogs by 20%.
- Investigated complex billing issues to identify root causes and produce actionable solutions improving payment accuracy.
- Identified coding discrepancies and corrected claim codes to prevent rejections and recover missed reimbursements.
- Educated members on coverage and claims, enhancing understanding and reducing repeat inquiries by 15%.
- Maintained comprehensive case documentation and tracked decision rationale, supporting compliance reviews and ensuring accurate audit trails.
Certified Nursing Assistant
Clove lakes
04.2012 - 09.2018
- Documented patient information in medical records to ensure accurate and timely care.
- Provided emotional support and companionship to enhance wellbeing of patients and families.
- Offered emotional support to patients and families during difficult times.
- Answered call lights promptly and responded to patient needs to improve overall patient satisfaction.
- Documented patient information accurately in medical records.
Education
GED -
Edison Job Corps
Edison, NJSkills
- Patient Advocacy & Care Coordination
- Care Coordination
- Claims Review & Resolution
- HIPAA Compliance
- ICD-10 Knowledge
- Healthcare Technology
- Quality Assurance
- Patient Engagement
Timeline
Care Navigator
Rightway Healthcare
11.2023 - Current
Claims Specialist
Express Scripts Pharmacy
06.2020 - 06.2023
Certified Nursing Assistant
Clove lakes
04.2012 - 09.2018
GED -
Edison Job Corps