Ashley Green
Irving,TX
Summary
Facilitates positive and productive interactions between workers, leaders and managers. Successful background reaching consensus and smoothing relations to maximize success of negotiations. Articulate and decisive professional with respectful and resourceful approach. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Provider Appeals & Grievance Specialist
Molina Healthcare
08.2020 - Current
- Responsible for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members and related outside agencies.
- Managed appeal cases for timely resolutions, enhancing company reputation.
- Improved customer satisfaction by efficiently handling and resolving grievances.
- Developed appeals functions, policies and procedures and documentation.
- Coordinated with senior specialist to compose appeal responses.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Reduced claim denial rates with thorough pre-appeal reviews, identifying potential issues before submission.
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
- Trained different agents on new processes and procedures.
Expense Sharing Specialist-Senior Mentor Lead
OneShare Health, LLC
07.2019 - 08.2020
- Reviews, researches, and finalizes expense requests within established timelines
- Analyzes providers needs and collaborates with other departments to identify opportunities to improve the One Share provider experience
- Provides timely, courteous, and professional follow-up to provider inquiries
- Provides subject matter expertise on payment and billing guidelines
- Carefully are accurately documents interactions with providers
- Attended training programs to deepen professional skillset and assisted in training fellow store associates on existing and new training programs.
- Helped meet changing demands by recommending improvements to business systems or procedures.
Claims Adjuster III
UnitedHealth Group
11.2014 - 07.2019
- Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization
- Review claims for financial responsibility including determining coordination of benefits
- Adjudicate claims appropriately per contract or standard processing guidelines which includes appropriate coding of CPT and ICD codes against charges that are being billed and entered
- Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
- Performs all other related duties as assigned.
- Reduced claim processing time by streamlining medical claims adjudication processes.
- Enhanced team efficiency by training junior adjusters in industry best practices.
- Improved customer satisfaction with timely and accurate claim settlements.
Education
High school or equivalent -
Baker High School
Baker, LAAssociate in Medical Billing and Coding -
DeVry University-Chicago
Irving, TX03.2017
Skills
- ICD-9
- ICD-10
- Microsoft Word
- Medical Records
- Microsoft Outlook
- Microsoft Excel
- Medical Information
- Customer Service
- Effective Communication
- Critical Thinking
- Multitasking Abilities
- Cross-functional Collaboration
Certification
Billing and Coding Specialist
Timeline
Provider Appeals & Grievance Specialist
Molina Healthcare
08.2020 - Current
Expense Sharing Specialist-Senior Mentor Lead
OneShare Health, LLC
07.2019 - 08.2020
Claims Adjuster III
UnitedHealth Group
11.2014 - 07.2019
High school or equivalent -
Baker High School
Associate in Medical Billing and Coding -
DeVry University-Chicago