Ashley Dunaway
Los Lunas,NM
Summary
Efficient professional in insurance claims and policy processing, known for high productivity and the ability to complete tasks with precision. Specialized in analyzing claim details, navigating policy databases, and managing customer communications. Excel in problem-solving, adaptability, and teamwork, leveraging these soft skills to navigate complex situations and achieve positive outcomes.
Overview
12
12
years of professional experience
Work History
Appeal Specialist
BCBS
Albuquerque, NM
04.2019 - Current
- Conducted thorough research on member and provider complaints, grievances, and appeals to ensure accurate resolution.
- Utilized various systems including Dashboard, Excel, Facets, Claims, Blue-chip, EAA, Image, WIM, Guiding Care, Evicore, Aerial, and Smart UM to manage and process appeals.
- Engaged in direct verbal communication with members and providers to address their needs.
Medical Assistant
Sandia National Laboratories - Albuquerque, NM
Albuquerque, NM
07.2018 - 02.2019
- Contacted medical facilities to schedule patients for admission.
- Positioned patients properly during examination or treatment for comfort and safety.
- Handled general office duties to support administrative staff during peak hours.
- Performed basic laboratory tests such as urinalysis and blood glucose levels under direct supervision of a physician or registered nurse.
- Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
- Documented notes during patient visits.
- Scheduled appointments for patients via phone and in person.
- Conducted EKGs, spirometry testing, audiograms and other diagnostic tests as requested by the physician.
- Communicated with pharmacies for prescription refills on behalf of supervising physician.
- Processed orders for medical supplies and lab equipment.
- Conducted patient interviews to gather health history, vital signs and information about current medical issues.
- Kept facility stocked with necessary supplies, equipment and instruments.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Ensured that all instruments used during exams were cleaned properly after each use according to established protocols.
- Secured patient information and maintained patient confidence by completing and safeguarding medical records.
- Assisted back office patient processes to reduce office wait times.
- Administered medications under physician's supervision.
- Ordered medical supplies, maintained inventory logs and restocked exam rooms when needed.
- Cleaned and maintained medical equipment following procedures and standards.
Medical Assistant
Enchantment Healthcare
Los Lunas, NM
04.2017 - 06.2018
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Exceeded customer satisfaction by finding creative solutions to problems.
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
- Administered injections, medications and treatments as directed by the physician.
- Responded to patient callbacks and phone-in prescription refill requests.
- Incorporated outside records into charts and EHR.
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Adhered to HIPAA regulations regarding safeguarding confidential patient information at all times.
- Organized patient charts before each day's clinic sessions began.
- Educated patients about medications, procedures and physician's instructions.
- Conducted routine laboratory tests and sample analyses to monitor diseases.
- Explained treatment procedures and physicians' instructions.
- Prepared laboratory specimens for analysis and organized lab results for review by the physician.
- Operated x-ray and electrocardiogram (EKG) to administer diagnostic tests.
- Prepared treatment rooms for patient examinations.
- Changed dressings on wounds to prevent infection and check for healing.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Answered phones, scheduled appointments, greeted patients and ordered supplies.
- Verified appointment times with patients, preparing charts, pre-admission and consent forms.
- Organized charts, documents and supplies to maintain team productivity.
Medical Assistant
DaVita HealthCare
Albuquerque, NM
04.2016 - 04.2017
- Positioned patients properly during examination or treatment for comfort and safety.
- Performed basic laboratory tests such as urinalysis and blood glucose levels under direct supervision of a physician or registered nurse.
- Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
- Documented notes during patient visits.
- Scheduled appointments for patients via phone and in person.
- Conducted EKGs, spirometry testing, audiograms and other diagnostic tests as requested by the physician.
- Communicated with pharmacies for prescription refills on behalf of supervising physician.
- Conducted patient interviews to gather health history, vital signs and information about current medical issues.
- Kept facility stocked with necessary supplies, equipment and instruments.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Secured patient information and maintained patient confidence by completing and safeguarding medical records.
- Administered medications under physician's supervision.
- Cleaned and maintained medical equipment following procedures and standards.
- Collected, labeled and stored laboratory specimens properly prior to testing.
- Collected samples from patients for laboratory testing purposes.
- Educated patients on healthcare topics such as nutrition and disease prevention methods.
Clinic Supervisor
Atrinea Health
Los Lunas, NM
02.2013 - 02.2016
- Assisted with resolving conflicts between staff members in a timely manner while upholding professional standards of conduct.
- Coordinated with medical staff to ensure adherence to clinical protocols and patient satisfaction.
- Oversaw ordering, purchasing and maintenance of clinical equipment.
- Tracked, organized and counted clinic stock and supplies.
- Implemented strategies to improve efficiency across all clinical departments.
- Provided training sessions to new employees on policies, procedures, and regulatory requirements related to clinic operations.
- Directed, supervised and evaluated medical, clerical or maintenance personnel.
- Led staff meetings to communicate updates, gather feedback, and discuss strategies.
- Maintained a safe and clean environment in compliance with health and safety standards.
- Implemented policy changes and communicated information and procedures through organizational staff meetings.
- Established and maintained relationships with insurance companies and other payers.
- Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
- Developed systems for tracking patient records and maintaining accurate documentation of treatments and procedures.
- Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
- Monitored inventory levels of supplies and equipment, ordering additional items as needed.
- Maintained awareness of government regulations, health insurance changes and financing options.
Education
MHA - Health Care Administration
Grand Canyon University
Phoenix, AZ03-2025
Bachelor of Science - Healthcare Administration
Grand Canyon University
Phoenix, AZ10-2019
Medical Assistant Certificate - Medical Assistant
Pima Medical Institute
Albuquerque, NM12-2006
Skills
- Medical coding
- Verbal communication
- Claims management
- Appeals processing
- Background in insurance
- Composing business correspondence
- Document review
- Adaptability and flexibility
- Time management abilities
- Teamwork and collaboration
- Organizational skills
- Interpersonal skills
- Professional demeanor
- Effective communication
- Organizing and prioritizing work
- Attention to detail
- Policy requirements and eligibility
- Multi-tasking
- Team building
- Time management
- Policy analysis
- Data entry
- Insurance terminology
Timeline
Appeal Specialist
BCBS
04.2019 - Current
Medical Assistant
Sandia National Laboratories - Albuquerque, NM
07.2018 - 02.2019
Medical Assistant
Enchantment Healthcare
04.2017 - 06.2018
Medical Assistant
DaVita HealthCare
04.2016 - 04.2017
Clinic Supervisor
Atrinea Health
02.2013 - 02.2016
MHA - Health Care Administration
Grand Canyon University
Bachelor of Science - Healthcare Administration
Grand Canyon University
Medical Assistant Certificate - Medical Assistant
Pima Medical Institute
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