Ashley Bullard

Monitored and validated benefits eligibility for scheduled appointments.

Accurate calculation of patient's estimated responsibility for scheduled services Determination of authorization/referral requirements according to payor guidelines

Validation of all authorizations/ referrals according to established guidelines

Determine if scheduled service is medically necessary according to payor guidelines Adherence to all documentation standards

• Maintain effective, professional communication with patients, physicians, medical office staff to ensure compliance with identified payor requirements
  Educate patients on insurance benefits and financial responsibility effectively
  Ability to perform all other duties as assigned or requested
• Work/facilitate spread sheets
  Op billing and collecting payments
  HMS,genesys,cerner,Kronos,ecare,Athena

• Served as a subject matter expert during dispute resolution meetings, providing clarity on policy interpretations when required.
• Enhanced client confidence in the grievance process through clear communication and empathetic handling of sensitive issues.
• Identified areas for policy improvement through thorough analysis of recurring grievance themes, leading to proactive problem resolution.
• Spearheaded initiatives for continuous improvement in the grievance management process, resulting in increased efficiency across the department.
• Maintained accurate records of all grievance cases, facilitating easier reporting and analysis of trends.
• Enhanced grievance resolution rates by implementing efficient tracking and monitoring systems.

• Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
• Increased team productivity through cross-training initiatives and sharing expert knowledge on complex claims scenarios.
• Managed high-volume caseloads, prioritizing cases based on urgency and complexity to achieve optimal results.
• Ensured compliance with industry regulations, conducting regular audits of claim files and documentation.
• Coordinated with other insurance carriers to resolve overlapping coverage disputes efficiently and fairly for all involved parties.
• Mentored junior Claim Benefit Specialists, sharing industry knowledge and best practices to strengthen overall team performance.

Adhered to contracted TAT by handling medical and hospital claim processes efficiently.

Research, investigate, negotiate, process, adjust and adjudicate medical claims.

Preforming check-work and voiding necessary claims for reprocessing

• Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
• Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
• Making outbound calls to obtain required information for re-consideration or first