Ashley Cruz
Herriman
Summary
Detail-oriented Case Reviewer with a strong focus on compliance and analytical thinking. Proven ability to manage prior authorizations and train new staff effectively.
Overview
10
10
years of professional experience
Work History
Case Reviewer
Medical Review Institute
West Valley
03.2018 - 12.2025
- Reviewed medical records to ensure compliance with industry standards.
- Analyzed case files for accurate medical necessity determination.
- Verified patient insurance coverage timely.
- Submitted prior authorization to Insurances ina timely matter.
- Collaborated with healthcare professionals to clarify case details.
- Assisted in training new staff on case review procedures and best practices.
- Adhered to all applicable laws regarding privacy rights when conducting investigations.
Prior Authorization Representative
Grangermedical
West Jordan
02.2016 - 03.2018
- Processed prior authorization requests for various medical services and procedures.
- Utilized electronic health record systems to track authorization status.
- Educated patients on authorization processes and requirements for services.
- Verified patient's insurance eligibility prior to appointment date for payment purposes.
- Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
Education
High School Diploma -
Hunter High School
West Valley City, UT06-2002
Skills
- Compliance review
- Medical necessity analysis
- Prior authorization submission
- Insurance verification
- Time management
- Flexible and adaptable
- Teamwork and collaboration
- Organizational skills
- Self-Directed
Accomplishments
Top Performer Award
Timeline
Case Reviewer
Medical Review Institute
03.2018 - 12.2025
Prior Authorization Representative
Grangermedical
02.2016 - 03.2018
High School Diploma -
Hunter High School