ASHLE PEGUES
Dallas
Summary
Dynamic healthcare administration and patient access professional with over 7 years of experience in enhancing healthcare operations, advocating for patients, coordinating care, and driving public health initiatives. Currently leveraging expertise in insurance claims management at State Farm, with a proven track record in case resolution, regulatory compliance, stakeholder communication, and service recovery. Recognized for effectively merging operational efficiency with a strong focus on customer and patient-centered care. Eager to transition back into non-clinical roles within healthcare administration, patient access management, and advocacy to continue making a meaningful impact.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Claims Specialist, Home & Fire Property
State Farm
Dallas, TX
07.2023 - Current
- Coordinate complex case handling, ensuring regulatory compliance, precise documentation, and prompt follow-up throughout the resolution process.
- Provide expert assistance and resources to individuals facing high-stress scenarios, ensuring effective navigation through their challenges.
- Engage with cross-functional teams to troubleshoot and resolve issues, balancing compliance with customer satisfaction.
Account Manager
PatientPoint
Dallas, TX
08.2022 - 12.2022
- Developed and maintained strong relationships with healthcare clients, focusing on seamless onboarding and sustained account success.
- Engaged with sales operations and analytics teams to ensure cohesive execution of client objectives.
- Utilized AI-powered CRM for in-depth analysis of engagement patterns, optimizing workflow processes to support data-driven decision-making.
Operations Lead
St. Louis County Department Of Public Health
St. Louis, MO
03.2021 - 08.2021
- Oversaw daily operational activities for large-scale public health clinics to enhance staff collaboration and optimize patient flow.
- Facilitated partnerships with clinical teams and agencies to ensure adherence to compliance and accessibility requirements in service delivery.
- Developed and implemented training programs for team members to improve knowledge of health protocols.
Health Guide
Vida Health, Inc.
St. Louis, MO
09.2020 - 04.2021
- Delivered comprehensive support and care coordination services to enhance patient management of chronic conditions.
- Managed documentation processes for interactions, promoting effective continuity of care across digital health platforms.
- Trained staff on digital health tools, promoting technology adoption for improved patient management efficiency.
Patient Care Coordinator
Mercy Virtual Care Center
Chesterfield, MO
01.2019 - 05.2020
- Achieved high member satisfaction by effectively onboarding new users to remote patient monitoring systems. Fostered daily communication to promote consistent usage and understanding of equipment. Empowered members through comprehensive training on device functionality.
- Assisted patients in scheduling referrals and managing insurance needs to enhance overall care accessibility.
- Streamlined collaboration between patients, providers, and payers to promote efficient access to healthcare resources.
Clinical Quality Data Analyst & Community Health Worker
People's Health Centers
St. Louis, MO
09.2016 - 01.2019
- Championed healthcare quality and population health initiatives to broaden access and improve patient outcomes.
- Analyzed data trends and partnered with care teams to address and reduce systemic obstacles faced by underserved populations.
- Developed and maintained dashboards using Tableau for real-time reporting of key performance indicators.
Education
Bachelor of Arts - Health Studies
University of Iowa
Iowa City, IA01-2019
Skills
- Healthcare management
- Patient access management
- Patient care coordination
- Account management
- Process optimization
- Proficient in CRM and EMR software
- Reporting and analytics
- Regulatory compliance
- Insurance and benefits support
Accomplishments
- Surpassed quarterly recruitment targets by 195%, personally onboarding 59 Primary Care Physicians (PCPs) against a goal of 20 per quarter.
- Ranked as a top individual contributor, responsible for 65% of the total team recruitment (59 out of 90 PCPs) in Q3 2022.
- Spearheaded large-scale clinical operations for the COVID-19 response, overseeing the administration of 100,000+ vaccinations across St. Louis County.
- Optimized public health workflows to facilitate rapid vaccine delivery, contributing to St. Louis County becoming the most highly vaccinated county in Missouri by late 2021.
- Honored with the Missouri Primary Care Award (Bronze) for excellence in value-based care delivery, focusing on improving patient outcomes and reducing long-term healthcare costs.
- Pioneered a Mobile Health Initiative partnership with Metro Transit to operate a mobile health screening van, bridging critical care gaps for underserved and transit-dependent populations.
Account Manager | PatientPoint (2022)
Operations Lead | St. Louis County Department of Public Health (2021)
Clinical Quality Data Analyst | People's Health Centers (2018)
Certification
HIPAA Compliance Certification | Texas All Lines Adjuster License
Timeline
Claims Specialist, Home & Fire Property
State Farm
07.2023 - Current
Account Manager
PatientPoint
08.2022 - 12.2022
Operations Lead
St. Louis County Department Of Public Health
03.2021 - 08.2021
Health Guide
Vida Health, Inc.
09.2020 - 04.2021
Patient Care Coordinator
Mercy Virtual Care Center
01.2019 - 05.2020
Clinical Quality Data Analyst & Community Health Worker
People's Health Centers
09.2016 - 01.2019
Bachelor of Arts - Health Studies
University of Iowa