Ashley Freeman
Grovetown,GA
Summary
Healthcare Administration professional with hands-on experience in prior authorization, claims processing, eligibility and benefits, and provider relations across payer and PBM environments. Proven ability to support time-sensitive, high-acuity cases, ensure regulatory compliance, and serve as a liaison between members, providers, and internal clinical teams. Passionate about maternal and reproductive health with a long-term goal of leadership in OB/GYN and women’s health administration.
Overview
5
5
years of professional experience
Work History
Prior Authorization Representative / Provider Spec
Brighton Health Plan Solutions
Remote
06.2025 - Current
- Manage prior authorization workflows for medical and pharmacy services, ensuring compliance with payer policies and regulatory requirements
- Serve as primary liaison between healthcare providers, members, and internal teams to resolve authorization, claims, and eligibility issues
- Verify eligibility, benefits, and authorization requirements to prevent delays in care
- Support providers by clarifying billing procedures, coding guidelines, and reimbursement policies
- Expedite time-sensitive authorizations through documentation review and provider follow-up
- Coordinate with internal departments to resolve claims disputes and payment issues
- Maintain strict HIPAA compliance while handling sensitive patient and provider information
Member Support Specialist
Blue Cross Blue Shield of Massachusetts
Remote
01.2024 - 01.2025
- Support members with eligibility, benefits explanation, and preauthorization processes
- Educate members on insurance coverage, cost-sharing, and care access
- Collaborate with provider offices to verify benefits and resolve authorization-related issues
- Advocate for members by addressing concerns and escalating complex cases appropriately
- Apply medical terminology knowledge to explain procedures and services clearly
- Maintain confidentiality and compliance with HIPAA regulations
Pharmacy Benefits Manager
Express Scripts Pharmacy
Remote
01.2022 - 01.2024
- Educated members on prescription drug benefits and coverage options
- Collaborated with healthcare providers to support appropriate medication use
- Reviewed prescriptions for accuracy, dosing, and potential interactions
- Maintained accurate drug records and compliance documentation
- Supported utilization and benefits education within a PBM environment
Payroll Manager
ADP
Augusta, GA
07.2020 - 11.2021
- Processed payroll, audits, garnishments, and compliance reporting
- Resolved discrepancies and provided subject matter expertise to stakeholders
Education
Bachelor of Science - Healthcare
Southern New Hampshire University
Hooksett, NHHigh School Diploma -
Thomas Walter Josey
Augusta, GA05.2008
Skills
Prior Authorization (Medical & Pharmacy)
Infertility & Women’s Health Services
Utilization Management Support
Eligibility & Benefits Verification
Claims Resolution & Provider Escalations
Provider Relations & Education
HIPAA & CMS Compliance
Member Advocacy (High-Sensitivity Cases)
Cross-Functional Care Coordination
Salesforce Jiva Call Center Operations
Timeline
Prior Authorization Representative / Provider Spec
Brighton Health Plan Solutions
06.2025 - Current
Member Support Specialist
Blue Cross Blue Shield of Massachusetts
01.2024 - 01.2025
Pharmacy Benefits Manager
Express Scripts Pharmacy
01.2022 - 01.2024
Payroll Manager
ADP
07.2020 - 11.2021
Bachelor of Science - Healthcare
Southern New Hampshire University
High School Diploma -
Thomas Walter Josey