Ashley De Los Santos

Overnight surgical tech

• Setup operating and surgery rooms by preparing equipment and supplies for upcoming procedures.
• Gathered and set up equipment, tools, and supplies and arrange instruments according to surgeons' preferences or instruction.
• Reduced infection risks and protected patients by maintaining sterile fields during procedures.

• Podiatry
• ENT
• GYN
• General
• Ortho (no totals)
• GI
• Demonstrated safe practices and procedures in store by adhering to company standards.

• Assist RN in preparing the O.R. for operation.
• Aids in transfer and positioning of patient.
• Maintaining sterility during all phases of surgery.
• Pass instruments, equipment, and medications to surgeon/physician assistant.
• Participate in preoperative counts with RN before and prior to the close of incision.
• Set up back table and mayo for procedure.
• Proficient in General, GYN, Vascular, Robots, and Urology cases.

• Maintain and update patient demographic information in Epic.
• Collect copays, deductibles, and coinsurance.
• Register 20-30 patients during shift.
• (PRN)
• Verified insurance benefits and obtained pre-authorizations before any medical procedures were performed.
• Assisted other clerks with front desk duties, answering questions and accurately using reservation system.

• Enter manual eligibility files received from Clients or Account Executives.
• Process manual member reimbursement requests.
• Maintain and scan all manual eligibility/reimbursement files.
• Maintain claims and eligibility spreadsheets
• Answer reimbursement questions.
• Creating denial letters.

• Run reports for Clients and Account Executives.
• Research/Resolve member issues sent from our Clients.
• Meet all set reporting deadlines.
• Assist Account Manager with any/all overflow work.

• Provide assistance to CSR’s.
• Responsible for training new CSR’s.
• Handle escalated phone calls for Mail Order and Maxor Plus depts.
• Respond to Contact Us inquires.
• Create tickets for MAC pricings received.
• Document and scan PHI forms received to member’s accounts.

• Provide assistance to pharmacies in processing claims.
• Verify member’s benefits.
• Initiate Prior Authorizations.
• Enter overrides per plan specifics.
• Enter member eligibility when necessary.
• Crossed trained in Mail Order Calls/Systems.

• Provide assistance to CSR’s.
• Handle escalated phone calls.
• Review escalated issues with Pharmacy Benefit Manager.
• Prepare summaries and reports of escalations.

• Provide excellent customer service.
• Verify member’s benefits.
• Review claims to make sure processed correctly.
• Resolve members inquires on a 1st call resolution.

• Resolve difficult prompts using resources. (blue source, fyiblue, ect.)
• Process claims according to guidelines and members policy.
• Maintain a balance between quality and quantity.
• Strive to provide member with excellent service.
• Handle special projects in a timely manner.

• Meet all training requirements.
• Enter billing information for claims to be processed.
• Process claims according to member’s policy.
• Provide and maintain quality work.