Ashley Moore
Brooklyn,NY
Summary
Utilization management professional with comprehensive experience in healthcare coordination and resource optimization. Skilled in data analysis, policy implementation, and compliance assurance. Strong emphasis on team collaboration and adaptability, consistently delivering impactful results in dynamic environments. Proven ability to effectively communicate with stakeholders, streamline processes, and drive efficiency.
Overview
11
11
years of professional experience
Work History
Care Management Navigator
VNS Health
11.2024 - Current
- Coordinate care plans with multidisciplinary teams to ensure comprehensive patient support.
- Implement process improvements to enhance workflow efficiency and patient satisfaction.
- Mentor junior navigators, fostering professional growth and operational knowledge.
- Develop training materials for new staff, streamlining onboarding procedures and enhancing team performance.
BCBS Dental Customer Service Rep
BCForward (Elevance Health)
05.2024 - 09.2024
- Responded to internal and external customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims.
- Assisted customers with website and benefit navigation.
- Thoroughly documented customer inquiries and outcomes for accurate tracking and record keeping.
- Developed and maintained positive customer relations and coordinated with various departments within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
- Contract
Customer Service Rep
Medix (Included Health)
08.2023 - 12.2023
- Communicate with patients and doctors.
- Excellent verbal skills are essential as you need to explain the services with confidence and have a friendly demeanor.
- Demonstrated attention to detail.
- Proficiency with technology; experience with Google apps, Apple products, and customer relationship management software.
- Worked independently to manage own workload while maintaining quality targets, department metrics, and exceeding member expectations.
- Demonstrated ability to think critically and problem solve complex situations.
- Be empathetic.
- Contract
Utilization Management Coordinator
One Home
10.2022 - 04.2023
- Obtained authorizations for all internal services from patient's PCP and/or managed care companies.
- Verified patient eligibility status for established patients.
- Obtained authorizations for patients.
- Reviewed daily schedules for potential pitfalls of unusual patient insurance coverage limitations or restrictions.
- Enter all notes and/or insurance changes into the system.
- Entered pertinent approval and denial information into the appropriate computer programs for Utilization Management team members to review and address in a timely manner.
- Remote
Epic Registration specialist
Avent Health Corp
06.2022 - 10.2022
- Responsible for providing virtual registration responsibilities, such as: Patient Registration, Insurance Verification and reviewing insurance claims.
- Processed request for adjustments, account type changes, guarantor mergers, and transfers when necessary, according to enterprise guidelines.
- Accurately entered patient demographics, guarantor and coverage information into EMR system.
- Provided patients with financial responsibility amount using epic estimates insurance company deductible copayment co-insurance and out of pocket amounts.
- Remote
Patient Service Representative
Change Healthcare
09.2020 - 12.2021
- Call center environment for NYC health and hospitals contact center.
- Accurately verified patients' insurance and demographics.
- Scheduled, Canceled, Confirmed patients' appointments for adult primary care and pediatric services. Sent emails and in basket messages to the appropriate department for scheduling appointments.
- Assisted pharmacies insurance companies and patients with medication refills, school form, clinical questions for providers and department staff.
- Protected patient confidentiality and complied with HIPPA laws.
- Assisted on the COVID line with scheduling confirming and rescheduling appointments for test and Vaccines.
- Remote
Utilization Management Coordinator
Elderplan Homefirst
12.2019 - 03.2020
- Answered incoming calls from ancillary providers, hospitals, and physician offices regarding prior authorization.
- Managed appropriate patient data.
- Sent Request for clinical records as per procedure.
- Applied appropriate policies, procedures, and eligibility and benefit policies.
- Referred request and notifications to licensed health professional for review.
- Reported suspected fraud and abuse as per company policy.
- Followed Medicare/Medicaid guidelines.
- Remote
Lead pre Authorization Coordinator
Columbia University Medical Center
New York, NY
03.2015 - 03.2019
- Provided pre certification for imaging services for all Columbia doctors.
- Collected and verified patients insurance coverage, pre-certification requirements for all patients.
- Updated IDX registration, prepared and completed paperwork in preparation of patient imaging service.
- Obtained all relevant patient clinical and demographic data from referring physician office or HER system Input pre-certification information and financial notes in IDX scheduling system as necessary.
Education
Associate in Science (AS) - Liberal Arts & Sciences
Borough of Manhattan CC
New York, NYAdvanced Regents Diploma - undefined
Brooklyn Academy High School
Brooklyn, NYSkills
CRM platform expertise
Billing inquiries management
Data validation
Detail-oriented data management
Timeline
Care Management Navigator
VNS Health
11.2024 - Current
BCBS Dental Customer Service Rep
BCForward (Elevance Health)
05.2024 - 09.2024
Customer Service Rep
Medix (Included Health)
08.2023 - 12.2023
Utilization Management Coordinator
One Home
10.2022 - 04.2023
Epic Registration specialist
Avent Health Corp
06.2022 - 10.2022
Patient Service Representative
Change Healthcare
09.2020 - 12.2021
Utilization Management Coordinator
Elderplan Homefirst
12.2019 - 03.2020
Lead pre Authorization Coordinator
Columbia University Medical Center
03.2015 - 03.2019
Advanced Regents Diploma - undefined
Brooklyn Academy High School
Associate in Science (AS) - Liberal Arts & Sciences
Borough of Manhattan CC