Ashley Davis
Lexington,SC
Summary
To Assist the Facility by following their Mission Statement, to assist the patients/clients as well as the team efficiently. Continuing to learn and expand my knowledge to perform to the best of my ability . Authorized to work in the US for any employer
Overview
15
15
years of professional experience
Work History
Remote Palliative Care Coordinator
Resolutioncare/Vynca
10.2021 - 07.2023
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Communicated with patients, ensuring that medical information was kept private.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care (Ie: Patient's PCP and/or specialists)
- Evaluates outcomes of care with the interdisciplinary team by measuring intervention effectiveness within the team on a monthly basis.
- Assisted about 100 patients daily with their palliative care needs along with a Nurse, MD, and Chaplain in a team environment.
- Also assisted the team's RN & MD with scheduling tele-health appointments daily and other patient needs, such as DME, Incontinence Supplies, Transportation, etc
Medicare TOC Program II / Lead
Absolute Total Care
12.2016 - 09.2020
- Assisted the Medicare Case Managers Daily, when notified their patient was admitted to the hospital and followed until discharged home.
- Received new members by emailed daily reports and assigned to the Case Managers available for outreach to the member and facility discharge planner
- Documented in the system (TruCare) of every Medicare member that was enrolled into CLTC
- Notified the member's PCP (if applicable) or their patients transition via fax with date of transition, facility, and diagnosis
- Researched Medical Records and Authorization information to confirm the admission, transfer & discharge details were correct and to determine if TOC was required
- Kept record of Case Managers schedules for assignment purposes
- Kept a daily excel spreadsheet of all members and transition details to be able to run reports upon a managers request and to assist with ideas to implement process changes to be able to work more efficiently
- Uploaded and Noted any correspondence received by fax or mail
- Assisted direct manager with training and interview Processes
- Additional Information:
- Top Performer while in this role and was first point of contact for any TOC related questions, issues, member updates, etc
- Helped create the Initial TOC Process and assisted with process changes under the TOC Committee and
- Completed 2 years of Medicaid-Medicare Dual Program (MMP) New Member Campaign with a success
- Worked under stringent daily deadlines.
Medicaid Inbound Member/Provider SR Customer Service Representative
Absolute Total Care
06.2008 - 12.2016
- Answered incoming member calls pertaining to Medicaid Eligibility, Benefits, Incentives, Issues/
- Complaints
- Answered Incoming Provider calls pertaining to claim status, billing errors/questions, pre-authorizations status/questions, web portal assistance, Issues/Complaints
- Team Player
- Diverse knowledge within other departments - Referral, Pharmacy, Provider Relations, Eligibility
- Departments as we worked together
- Average 80 calls daily depending on volume.
Education
High school diploma or GED -
Mid Carolina High School
Prosperity, SCSkills
- Medical Records (10 years)
- Medical Terminology (10 years)
- Microsoft Office (10 years)
- Research (10 years)
- Team Leader (7 years)
- Organizational Leadership (3 years)
- Data entry (10 years)
- Documentation review (5 years)
- ICD-10 Knowledge
- Customer Care
- Benefits Verifications
- Conflict Resolution Techniques
- Problem Resolution
- Microsoft Outlook Calendar
- Home health & DME Experience
- Record Retrieval
Timeline
Remote Palliative Care Coordinator
Resolutioncare/Vynca
10.2021 - 07.2023
Medicare TOC Program II / Lead
Absolute Total Care
12.2016 - 09.2020
Medicaid Inbound Member/Provider SR Customer Service Representative
Absolute Total Care
06.2008 - 12.2016
High school diploma or GED -
Mid Carolina High School
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