Ashley Hills
Ovid,MI
Summary
Dynamic Appeals Specialist with a proven track record at the University of Michigan Health Plan, adept at enhancing claim processing efficiency through meticulous documentation review and creative problem-solving. Skilled in EMR systems and referral verification, I excel in fostering strong relationships with healthcare providers to streamline operations and improve patient outcomes.
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
22
22
years of professional experience
Work History
Appeals Specialist
University of Michigan Health Plan
07.2023 - Current
- Analyzed and processed appeal requests, ensuring compliance with regulatory standards.
- Collaborated with cross-functional teams to develop streamlined appeal resolution protocols.
- Reviewed documentation for accuracy, identifying discrepancies to enhance claim processing efficiency.
- Created, composed and maintained appeal response templates.
- Streamlined data management processes by maintaining organized records of all appeal cases, tracking progress, and updating relevant parties as needed.
Referral Specialist
Alliance Ob/Gyn
01.2014 - 07.2023
- Process referral requests for 20 providers and other outside health care professionals.
- Obtained prior authorization for Radiology procedures.
- Developed and maintained strong working relationship with referral sources to streamline processing.
- Assisted with discharge planning coordination and post-acute care referrals.
- Monitored referrals to foster timely completion and followed up with physicians to facilitate.
- Accessed and reviewed patient records to verify receipt completed referral paperwork.
- Responded to patient inquiries to offer timely updates regarding referral status.
- Answered 75+ telephone calls to offer office information, answer questions, and direct calls to staff.
- Scheduled appointments with specialists on behalf of clients.
Front Desk Receptionist
Genesis Diagnostic Center/Breast Center Of Lansing
04.2004 - 01.2014
- Maintained confidentiality of sensitive data to protect customer and business information.
- Welcomed customers with friendly greeting, answered general questions, gathered nature of visit and directed to specific offices.
- Assisted internal staff with clerical and administrative needs to maximize efficiency and team productivity.
- Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
- Collected balance and self pay payments, processed transactions and updated relevant records.
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Maintained schedules and referrals from multiple offices.
- Confirmed appointments, communicated with clients, and updated client records
- Handled assignments independently with good judgement and critical thinking skills
- Managed over 50 customer calls per day.
Education
Associate of Applied Science -
Lansing Community College
Lansing, MI05.2004
High School Diploma -
Laingsburg High School
Laingsburg, MI05.2001
Skills
- Understanding of HIPAA standards
- Commitment to ongoing learning
- Innovative problem-solving
- Medical evaluation summaries
- Confidential document handling
- Analytical problem-solving
- Skilled in navigating appeals procedures
- Proficient in managing multiple tasks
- Effective troubleshooting skills
- Claims analysis
- Strong communication skills
References
Patricia Adams-Appeals and Grievance Manager
517-936-3081, Padams18@hap.org
Dr. David Anderson
517-402-2018, ande1609@msu.edu
Taylor Brennan
517-242-4904, Tayloann90@gmail.com
Dawn Ellis
517-749-0884, dawn0925@comcast.net
Timeline
Appeals Specialist
University of Michigan Health Plan
07.2023 - Current
Referral Specialist
Alliance Ob/Gyn
01.2014 - 07.2023
Front Desk Receptionist
Genesis Diagnostic Center/Breast Center Of Lansing
04.2004 - 01.2014
Associate of Applied Science -
Lansing Community College
High School Diploma -
Laingsburg High School