Ashley Gates
Summary
Dynamic insurance professional with extensive experience at JET Health, excelling in leadership and problem resolution. Proven track record in insurance verification and prior authorization, enhancing operational efficiency. Adept at training and development, with a strong work ethic and attention to detail, driving team success and improving patient care outcomes.
Overview
9
9
years of professional experience
Work History
Supervisor - Insurance & Auth Department
JET Health
Fort Worth
12.2020 - Current
- Monitored employee productivity to provide constructive feedback and coaching.
- Coordinated employee schedules according to shift changes and availability.
- Responded to employee concerns or complaints by coordinating with human resources team to solve issues.
- Identified and corrected performance and personnel issues to reduce impact to business operations.
- Interviewed applicants, recommended individuals for hiring and evaluated staff performance.
- Provided ongoing training to address staff needs.
- Established and enforced clear goals to keep employees working collaboratively.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Set specific goals for projects to measure progress and evaluate end results.
- Updated patient and insurance data and input changes into company computer system.
- Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Communicated with insurance carrier, patient and third party or employer to verify patient insurance benefits.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Investigated and resolved issues to maintain billing accuracy.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Worked with team members and leadership to identify and develop process improvements.
- Prepare training tools for home health and hospice agencies to ensure accurate benefits and authorization.
- Train new employees on insurance, authorization and intake processes.
Insurance Verification Specialist
AngMar Medical Holdings
Mansfield
08.2018 - 12.2020
- In my current position, I handle insurance verification as well as authorization for multiple branches for a multi-state home health company.
- I work with my branches to obtain proper documentation needed for authorization and to bill claims.
- I keep up with daily tasks in my workflow while multi-tasking to address emails as well as incoming phone calls.
- I also provide support for coworkers as needed with their tasks and pride myself on being an all around team player.
- Updated patient and insurance data and input changes into company computer system.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Accessed third-party insurance databases to identify coverage of benefits.
- Navigated through multiple online systems to obtain documentation.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
Customer Service Representative
Aerocare Home Medical
05.2019 - 08.2019
- I am experienced at qualifying patients by insurance guidelines for durable medical equipment along with obtaining authorization from insurance companies for billing purposes.
- Most recently I have been given the task of qualifying all non-invasive ventilators for my region, covering the doctors offices and hospitals for the following offices; Fort Worth TX, Granbury TX, Dallas TX and Sanger TX.
- I am knowledgeable in insurance qualifications and trouble shooting for the following durable medical equipment; invasive ventilation, 50 PSI, oral and tracheotomy suctioning, tracheotomy supplies, enteral tube feeding, oxygen, nebulizers, walkers, wheelchairs, hospital beds and different types of support surfaces, negative pressure wound therapy, IPPV machines, bathroom equipment, CPAP and BiPap machines, CPM machines as well as patient lifts.
- I answer high volume phone calls, return voicemails, work faxes and assist walk in patients with their needs and questions.
Lead Auditor
Landmark Healthcare
06.2017 - 01.2019
- I am experienced at qualifying patients by insurance guidelines for durable medical equipment along with obtaining authorization from insurance companies for billing purposes.
- I am knowledgeable in insurance qualifications and trouble shooting for the following durable medical equipment; invasive ventilation, 50 PSI, oral and tracheotomy suctioning, tracheotomy supplies, enteral tube feeding, oxygen, nebulizers, walkers, wheelchairs, hospital beds and different types of support surfaces, negative pressure wound therapy, IPPV machines, bathroom equipment, CPAP and BiPap machines, CPM machines as well as patient lifts.
- I answer high volume phone calls, return voicemails, work faxes and assist walk in patients with their needs and questions.
- While with Landmark I handled most of their on call and after hours issues including working with weekend hospital staff to get patients qualified for equipment so they could discharge home in a timely manner.
Customer Service Representative
Pacific Pulmonary Services
10.2016 - 05.2017
- I am experienced at qualifying patients by insurance guidelines for durable medical equipment along with obtaining authorization from insurance companies for billing purposes.
- I am knowledgeable in insurance qualifications for the following durable medical equipment; invasive ventilation, 50 PSI, oral and tracheotomy suctioning, tracheotomy supplies, enteral tube feeding, oxygen, nebulizers, walkers, wheelchairs, hospital beds and different types of support surfaces, negative pressure wound therapy, IPPV machines, bathroom equipment, CPAP and BiPap machines, CPM machines as well as patient lifts.
- I answer high volume phone calls, return voicemails, work faxes and assist walk in patients with their needs and questions.
Education
High School - Basic Studies
Weatherford High School
05.2006
Skills
- Homecare Homebase and WellSky
- Forcura and WayStar
- Palmetto and payor sites
- Leadership and problem resolution
- Strong work ethic
- Microsoft Office Suite
- Excel, Word, and PowerPoint
- Microsoft Teams
- Training and development
- Attention to detail
- Insurance verification and prior authorization
- Program advisement and understanding
- Policy development
- Claims Denials
Volunteer Experience
Granbury Baptist Church, Deaf Ministry
Bear Creek Community Church, Food Ministry and Worship group
Waxahachie Farmer's Market
References
- Darren Wexler, Regional Manager, Pacific Pulmonary Services, 817-233-8480
- Lacey Karlik, Customer Service Manager, Landmark Healthcare, 817-917-4312, lacey.karlik@landmarkhc.com
- Stephen Miller, Former Reimbursement Supervisor, 817-739-1183
- Joel Pesaresi, Quality Control Manager, Landmark Healthcare, 817-840-8565
Languages
Basic
Personal Information
Hobbies: Church Activities, Entertaining, Listening to Music, Reading, Singing, Volunteering, Watching Movies, Family Time
Timeline
Supervisor - Insurance & Auth Department
JET Health
12.2020 - Current
Customer Service Representative
Aerocare Home Medical
05.2019 - 08.2019
Insurance Verification Specialist
AngMar Medical Holdings
08.2018 - 12.2020
Lead Auditor
Landmark Healthcare
06.2017 - 01.2019
Customer Service Representative
Pacific Pulmonary Services
10.2016 - 05.2017
High School - Basic Studies
Weatherford High School