Ashley Mao
Fresno,CA
Summary
Dependable employee establishes rapport and trust with patients and helps complete daily living tasks to enhance quality of life. Driven to prioritize individual needs with attention to important details. Valued as accommodating, kind-hearted team player dedicated to expanding knowledge and responsibilities in the healthcare field.
Overview
7
7
years of professional experience
Work History
Care Provider
In Home Supportive Services (IHSS)
06.2017 - Current
- Provided transportation and managed doctor appointments
- Assisted clients with dressing, feeding needs, grooming, bathing, and overcome mobility restrictions
- Entrusted to handle confidential and sensitive information in a professional manner
- Developed rapport in creating a safe and trusting environment for care.
- Maintained clean personal areas and prepared healthy meals to support client nutritional needs.
- Organized medication and provided reminders according to schedule.
- Reduced patient anxiety and stress through effective communication and active listening skills.
Provider Relations Representative - Contracting
Wollborg Michaelson
02.2024 - 07.2024
- Healthcare industry/provider network expertise, including data analysis, provider contract language
- Maintained an effective provider network and relationships with IPAs/medical groups, physicians, and ancillary providers
- Achieved quantifiable goals and targets for the assigned network of providers, servicing healthcare providers and responding to their inquiries
- Ensuring healthcare providers are credentialed in accordance with BSC’s policies
- Ability to influence providers and build strong provider relationships and effective communication
- Coordinate with TriWest to resolve escalated claim issues and necessary research timely and effectively.
Medical Claims Examiner
Sante Health Systems
10.2021 - 05.2022
- Effectively analyzed and coordinated benefits for payment on health claims
- Processed 100+ medical claims, and routine dental claims, ensuring plan coverage and ICD codes are accurate
- Adjudicate claims in accordance with policies, procedures, state and accreditation standards
- Consistently exceeds quality and production goals
- Adding of providers, BSBC software, pricing of claims, and accessing a variety of network system claims
- Special process and paid out hospital claims, including high dollar claims accurately and confidentiality.
Health Concierge, CSR
Aetna Healthcare Insurance
04.2017 - 03.2018
- Acted as a health concierge being the face of Aetna to provide world class customer service, and providing targeted, personalized service based on the members benefits, health information and through engagement
- Managed 50+ calls a day answering questions and resolves issues as a single point of contact based on phone calls, plan sponsors, and ISO members/providers
- Provided member with related information to answer the unasked questions, additional plan details, benefit plan details and self-service tools
- Take ownership of each members contact to resolve their issues and connect with them.
- Participated in ongoing professional development opportunities to stay current on industry best practices and enhance the quality of care provided.
Education
Associate degree in Pre-Allied Health -
Fresno City College
Fresno, CA05.2024
High School Diploma -
Sunnyside High School
Fresno, CA06.2014
Skills
- Health plan operations
- Healthcare Industry Knowledge
- Provider support
- Dispute Resolution
- HIPAA Compliance
- Claims Processing
- Call center experience
- Attention to Detail
- Time Management
- Problem-Solving
- Compassionate Caregiving
- Patient Care
- Care Plan Management
- Critical Thinking
Timeline
Provider Relations Representative - Contracting
Wollborg Michaelson
02.2024 - 07.2024
Medical Claims Examiner
Sante Health Systems
10.2021 - 05.2022
Care Provider
In Home Supportive Services (IHSS)
06.2017 - Current
Health Concierge, CSR
Aetna Healthcare Insurance
04.2017 - 03.2018
Associate degree in Pre-Allied Health -
Fresno City College
High School Diploma -
Sunnyside High School
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