Ashley Morehead
Altamonte Springs,FL
Summary
Experienced Specialty Pharmacy professional in pursuit of a long-term career utilizing years of operational and managerial experience to contribute to the growth and success of a respected organization that offers a positive atmosphere to learn and implement new skills and technologies.
Overview
13
13
years of professional experience
Work History
Billing Supervisor
BioPlus Specialty Pharmacy
09.2020 - Current
- Managing the Billing team who are responsible for processing & auditing pharmacy claims.
- Collaborating with Account Managers, Project Managers & Operational departments on new system implementations and testing new processes.
- Point of contact for reviewing and resolving urgent escalations.
- Accomplishing departmental objectives by supervising staff while also organizing and monitoring their work processes.
- Creating and updating SOP's for Billing department.
- Interviewing, hiring and training new employees.
Lead Intake & Insurance Verification Coordinator
AcariaHealth Specialty Pharmacy
08.2019 - 09.2020
- Promotion to Lead Coordinator for the Iclusig team.
- Processing referrals for patients who are in crisis status using critical thinking skills to make key judgement calls.
- Assist with managing team workload to ensure that referrals and orders are processed in timely manner.
- Monitor work queue through various reports and redistribute work as appropriate.
- Serve as point of contact for key physicians offices and coordinate referrals with sales team during insurance verification process.
Insurance Verification Coordinator
AcariaHealth Specialty Pharmacy
04.2018 - 08.2019
- Lateral move to the Insurance verification department.
- Obtain and verify insurance eligibility for services provided and document complete information in system.
- Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies.
- Collecting all pertinent clinical information such as lab values, diagnosis codes, etc.
- Determine patients financial responsibilities as stated by insurance and apply applicable copay assistance.
Data Entry Specialist II
AcariaHealth Specialty Pharmacy
06.2016 - 04.2018
- Promotion to the Analytics department.
- Processing daily reports for the sales and operational departments.
- Identifying and resolving data errors for resubmission to multiple pharmaceutical programs.
- Data entry consisting of patient demographic and insurance information.
- Data mining.
- Utilizing Microsoft Excel & Access to produce weekly and monthly financial reports.
Submissions Problem Coordinator
AcariaHealth Specialty Pharmacy
07.2015 - 06.2016
- Promotion to the insurance verification department.
- Processing claims for orders that fall into the Submission Problems work queues due to claim rejections and/or other claims processing issues.
- Processing copay cards and/or credit card payments.
- Working in conjunction with multiple insurance verification departments and pharmacists to resolve insurance issues in a timely and efficient manner.
- Monitoring and resolving any software or system glitches and identifying trends that prevent orders from processing and reporting them to tech support as needed.
Patient Care Coordinator
AcariaHealth Specialty Pharmacy
12.2014 - 07.2015
- Scheduling and coordinating delivery of specialty medication with patients and/or doctors offices.
- Providing customer service for inbound calls as needed.
- Meeting and exceeding metric goals consistently.
- Taking on additional assignments and projects as assigned by management.
Member Services Representative
MHNet Behavioral Health
06.2011 - 12.2014
- Duties include taking incoming and making outbound calls in a high-volume call center for a behavioral health insurance company.
- Assisting members and providers with benefits, authorizations, referrals and claims issues.
Education
Associate of Science - Medical Office Administration
Valencia College
Orlando, FL2011
Skills
- Team Leadership
- Insurance Verification
- Claims Processing
- Reporting Skills
- Organizational Skills
- Attention to Detail
- Analytical Skills
- Research and Due Diligence
- HIPAA Compliance
Timeline
Billing Supervisor
BioPlus Specialty Pharmacy
09.2020 - Current
Lead Intake & Insurance Verification Coordinator
AcariaHealth Specialty Pharmacy
08.2019 - 09.2020
Insurance Verification Coordinator
AcariaHealth Specialty Pharmacy
04.2018 - 08.2019
Data Entry Specialist II
AcariaHealth Specialty Pharmacy
06.2016 - 04.2018
Submissions Problem Coordinator
AcariaHealth Specialty Pharmacy
07.2015 - 06.2016
Patient Care Coordinator
AcariaHealth Specialty Pharmacy
12.2014 - 07.2015
Member Services Representative
MHNet Behavioral Health
06.2011 - 12.2014
Associate of Science - Medical Office Administration
Valencia College
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