Ashley Bradley
Houston,TX
Summary
Dynamic Utilization Management Coordinator at Wellsense Health Plan with expertise in patient data analysis and workflow efficiency improvement. Proven track record in facilitating timely authorizations and enhancing care management strategies. Strong critical thinking skills complemented by a commitment to HIPAA compliance and documentation accuracy, driving successful outcomes in complex healthcare environments.
Overview
7
7
years of professional experience
Work History
Utilization Management Coordinator
Wellsense Health Plan
Boston, MA
05.2023 - Current
- Coordinated utilization review processes to ensure compliance with health plan policies.
- Analyzed patient data to identify trends and optimize care management strategies.
- Collaborated with healthcare providers to facilitate timely authorizations for services.
- Monitored treatment plans for adherence to clinical guidelines and best practices.
- Developed training materials for staff on utilization management procedures and tools.
- Implemented quality assurance measures to enhance accuracy in documentation and reporting.
- Facilitated interdisciplinary meetings to discuss complex cases and improve service delivery.
- Resolved provider inquiries related to authorization processes, ensuring clear communication of requirements.
- Collaborated with multidisciplinary teams to develop individualized care plans for patients.
- Maintained accurate documentation of all reviews, appeals, and decisions in line with organizational standards and requirements.
- Improved workflow efficiency by collaborating with healthcare providers to ensure timely authorizations and discharge planning.
Prior Authorization Representative
Cigna
04.2020 - 05.2023
- Process prior authorization requests efficiently to ensure timely patient access to medications.
- Collaborate with healthcare providers to obtain necessary documentation for authorization approvals.
- Review and analyze medical records to determine eligibility for insurance coverage.
- Maintain accurate records in electronic health systems, ensuring compliance with regulations.
- Communicate effectively with patients regarding authorization status and required information.
- Assist in training new representatives on internal policies and procedures related to authorizations.
- Identify trends in authorization denials and recommend process improvements to enhance efficiency.
- Support cross-functional teams in resolving complex authorization issues, fostering collaboration between departments.
Customer Service Representative
Asurion
Houston, TX
04.2019 - 03.2020
- Resolved customer inquiries efficiently through phone and chat support channels.
- Trained new representatives on company policies and customer service best practices.
- Implemented process improvements that enhanced response times for customer issues.
- Collaborated with cross-functional teams to streamline issue resolution workflows.
- Analyzed customer feedback to identify trends and recommend service enhancements.
- Led initiatives to improve customer satisfaction scores through targeted training sessions.
- Mentored junior staff, fostering professional growth and improving team performance.
- Developed training materials that contributed to onboarding efficiency for new employees.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
Education
Medical Billing And Coding
University of Phoenix
Tempe, AZDiploma -
Klein Forest High
Houston Texas 06.2011
Skills
Case management proficiency
- Clinical guidelines
- Quality assurance
- Interdisciplinary collaboration
- Documentation accuracy
Patient data analysis
Care management strategies
Authorization facilitation
Provider inquiry resolution
Documentation accuracy
Workflow efficiency improvement
Prior authorization processing
Medical record review
Electronic health systems maintenance
Authorization denial analysis
Process improvement recommendations
HIPAA compliance awareness
Critical thinking
Insurance verification
Medical terminology
Time management mastery
Healthcare regulations
Case management proficiency
Timeline
Utilization Management Coordinator
Wellsense Health Plan
05.2023 - Current
Prior Authorization Representative
Cigna
04.2020 - 05.2023
Customer Service Representative
Asurion
04.2019 - 03.2020
Diploma -
Klein Forest High
Medical Billing And Coding
University of Phoenix