Ashley F. Koya
Azle,TX
Summary
Dedicated healthcare professional with over a decade of hands-on experience managing and auditing medical records in fast-paced, compliance-driven environments. I’ve built my career on accuracy, accountability, and heart, making sure every record is handled with care and each request is treated like a patient, providing confidentiality and purpose. From ROI operations to quality assurance, I know how to spot the small details that make a big difference in protecting patient information and improving workflow efficiency. I’m passionate about upholding HIPAA standards, supporting my team, and helping healthcare systems run smoother and smarter. I am also a reliable, collaborative team member and have been in the HISII role for 6 years.
Overview
14
14
years of professional experience
Work History
Health Information Specialist II
Datavant Aka CioxHealth
01.2020 - Current
- Managed health information systems to ensure data accuracy and compliance with regulatory standards.
- Streamlined patient data retrieval processes, reducing turnaround time for medical record requests.
- Conducted audits of patient records to maintain data integrity and support quality assurance initiatives.
- Completing Digital Auth Reviews within Healthsource
- Completing all Hedis Audit requests in a timely manner.
- Working with multiple different EMR systems for each Hospital/Facitlity
- Ensured timely processing of patient information to support effective care delivery.
- Conducted regular audits of medical records to identify discrepancies and areas for improvement in documentation practices.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Assist in training new employees on sites that require backup.
- Provide professionalism and respect to leadership and team members.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Followed exact procedures for handling transfers and other releases of medical records.
- Editing SOP when new processes are implemented for a specific facility or site number.
Crisis Intervention Specialist- Part Time
Elevance Health
07.2022 - 03.2023
- Provided crisis intervention and support to individuals in emotional distress.
- Skilled in active listening and empathetic communication with individuals experiencing suicidal ideation.
- Worked collaboratively with mental health professionals and crisis intervention teams to provide comprehensive support to clients.
- Experience in providing crisis intervention and suicide prevention support via text and chat.
- Proficient in conducting risk assessments and developing safety plans for clients in crisis.
- Demonstrated ability to remain calm under pressure and respond effectively to emergency situations.
- Committed to ongoing training and professional development in the field of suicide prevention and crisis intervention.
Patient Access Coordinator
The West Cancer Center
02.2019 - 12.2019
- Managed scheduling for cancer patients in a fast-paced healthcare setting.
- Managed appointment scheduling and patient communication for oncology clinic.
- Coordinated treatment plans and follow-up appointments for cancer patients.
- Ensured accuracy and completeness of patient records and documentation.
- Collaborated with healthcare providers to optimize scheduling efficiency.
- Provided empathetic support and information to patients and their families.
- Utilized electronic health record systems to update and maintain patient information.
- Facilitated communication between patients, caregivers, and healthcare team.
- Germantown, TN
Utilization Review Specialist
Methodist Hospital Health Care System
07.2017 - 01.2019
- Verified patient insurance coverage and confirmed that prior authorizations were obtained for outpatient procedures and services.
- Cross-checked authorization details to ensure the correct medical codes (CPT, ICD-10) were applied, avoiding claim delays or denials.
- Collaborated with outpatient care patients to address insurance-related concerns, providing clear explanations of authorization statuses and next steps.
- Liaised with healthcare providers and administrative staff to secure missing information, update authorizations, or resolve discrepancies.
- Maintained organized and up-to-date records of prior authorizations, approvals, and denials, ensuring compliance with regulatory standards such as HIPAA.
- Proactively addressed potential issues in the authorization process, minimizing interruptions to patient care and improving operational workflows.
- Richardson, TX
Provider Administration Representative
Superior Medical Management
12.2014 - 07.2017
- Managed the resolution of underpayment issues by creating and submitting appeals to insurance carriers, ensuring accurate reimbursement for providers.
- Reviewed payment data to verify payment accuracy, addressing discrepancies and ensuring compliance with contractual agreements.
- Provided clients and providers with up-to-date payment statuses, including claim adjustments and pending payments, fostering clear communication and transparency.
- Worked closely with internal teams to resolve claims denials and payment issues, maintained detailed records of appeals and payment statuses, and ensured all processes adhered to HIPAA and billing regulations.
- Dallas, TX
Claims Customer Service Representative (Claims CSR)
North Texas Specialty Physicians
02.2014 - 11.2014
- Served as the primary point of contact for clients and providers regarding claims inquiries, ensuring clear communication and timely resolution of issues.
- Assisted in processing and verifying claims, reviewed payment accuracy, and provided updates on claim statuses.
- Worked with claims departments to address underpayment, claim denials, and payment discrepancies, creating and submitting appeals when necessary.
- Maintained detailed records of interactions and claims, ensured compliance with company policies and HIPAA regulations, and worked diligently to deliver high-quality customer service while fostering positive relationships with clients and providers.
- Fort Worth
Customer Claims Care Representative (CCR)
Valence Health Insurance Systems
01.2012 - 02.2014
- Took inbound calls from both members and providers regarding claim payments, statuses, and benefit information, ensuring clear and accurate communication.
- Reviewed claims for payment accuracy, resolved underpayment issues, and addressed claim denials, creating and submitting appeals when necessary.
- Provided detailed information about covered and non-covered services, helping members and providers understand their benefits.
- Maintained detailed records of all interactions, ensured compliance with company policies and HIPAA regulations, and contributed to process improvements to enhance department efficiency and effectiveness.
- Bedford, TX
Education
Bachelor of Science - Human Services & Healthcare Management
Walden University
Minneapolis, MN06.2028
High School Diploma - AP English, Science
Juan Seguin High School
Arlington, TX08.2008
Skills
- Regulatory audit documentation & compliance reporting
- Data integrity validation & error trend analysis
- Workflow optimization & process improvement
- Cross-functional collaboration with QA and compliance teams
- HealthSource and EHR system proficiency
- Ethical data stewardship and confidentiality advocacy
Languages
Hindi
English
Timeline
Crisis Intervention Specialist- Part Time
Elevance Health
07.2022 - 03.2023
Health Information Specialist II
Datavant Aka CioxHealth
01.2020 - Current
Patient Access Coordinator
The West Cancer Center
02.2019 - 12.2019
Utilization Review Specialist
Methodist Hospital Health Care System
07.2017 - 01.2019
Provider Administration Representative
Superior Medical Management
12.2014 - 07.2017
Claims Customer Service Representative (Claims CSR)
North Texas Specialty Physicians
02.2014 - 11.2014
Customer Claims Care Representative (CCR)
Valence Health Insurance Systems
01.2012 - 02.2014
High School Diploma - AP English, Science
Juan Seguin High School
Bachelor of Science - Human Services & Healthcare Management
Walden University