Ashley Otwell
Marshall,TX
Summary
Experienced Quality Auditor with well-honed analytical skills with regulatory compliance auditing experience. Solution-focused professional highly-regarded among peers and supervisors. Skilled auditor who works diligently with all levels of peers, management and external authorities.
Overview
14
14
years of professional experience
Work History
Quality Auditor
HCSC, Blue Cross Blue Shield Of Texas
03.2022 - Current
- Calculated adjustments, benefits and refunds.
- Experience analyzing and resolving problem claims issues.
- Recognizing errors and discrepancies in claims processing procedures.
- Blue Chip and/or Blue Star system.
- PC proficiency to include Microsoft Word and Excel.
- Understanding of medical terminology and CPT, HCPCS, and ICD9 coding
- Auditing internal audits for books of business to include FI,ASO,ERS,HMO,AIM.
Sr Claims Technician
HCSC, Blue Cross Blue Shield Of Texas
02.2019 - 03.2022
- Processing variety of claims from different books of business including Texas FI,ASO,HMO,IMAGE.
- Manually calculating claims to process and pay correctly.
- Experience using systems such as Bluechip, ARIS, Bluesquared,MPUI,RTB,FSS, Premier,Etc.
- Experience including Windows and Microsoft Office.
- Ability to multi-task and prioritize.
Customer Service Advocate
HCSC, Blue Cross Blue Shield Of Texas
06.2014 - 02.2019
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Learned and maintained in-depth understanding of product information, providing knowledgeable responses to diverse questions.
- Experience evaluating customer situations, making decisions, and responding quickly to questions
- Experience in different departments to include, provider services,members services and the Virtual unit.
- Blue Card/ITS experience in researching, identifying, and resolving discrepancies, problem solving, and project management.
Phlebotomist
Clinical Pathology Laboratories, Inc.
12.2012 - 06.2014
- Labeled transfer tubes and followed exact directions for handling and storing specimens for transport.
- Completed proper sanitation and cleaning of equipment and work areas between patients.
- Centrifuged blood samples as outlined in clinical protocols.
- Established and maintained positive working relationships with patients, staff and clinical personnel to build trust and camaraderie.
- Used personal protective equipment correctly to protect coworkers and patients.
- Tracked collected specimens by initialing, dating, and noting times of collection.
- Addressed questions and concerns to educate patients on collection process and procedures.
- Stocked phlebotomy cart or carrier with appropriate supplies.
- Assembled tourniquets, needles, and blood collection devices to prepare work trays.
- Packaged and shipped specimens to central lab daily.
- Monitored patients for reactions and verified sample quality.
- Conducted venipuncture and other CT procedures.
- Adhered to HIPAA standards and maintained patient confidentiality in all interactions.
- Drew blood from veins by vacuum tube, syringe, or butterfly venipuncture methods.
- Followed established safety protocols and standards to minimize risk of infection and injury.
- Assisted in training and onboarding new phlebotomists.
Phlebotomist
Good Shepherd Medical Center
02.2010 - 11.2012
- Labeled transfer tubes and followed exact directions for handling and storing specimens for transport.
- Completed proper sanitation and cleaning of equipment and work areas between patients.
- Centrifuged blood samples as outlined in clinical protocols.
- Established and maintained positive working relationships with patients, staff and clinical personnel to build trust and camaraderie.
- Stocked phlebotomy cart or carrier with appropriate supplies.
- Addressed questions and concerns to educate patients on collection process and procedures.
- Tracked collected specimens by initialing, dating, and noting times of collection.
- Used personal protective equipment correctly to protect coworkers and patients.
- Assembled tourniquets, needles, and blood collection devices to prepare work trays.
- Packaged and shipped specimens to central lab daily.
- Monitored patients for reactions and verified sample quality.
- Organized daily work based on collection priority.
Education
Associate of Science - Nursing
Tyler Junior College
Tyler, TXNo Degree - Emergency Medical Technology
Panola College
Carthage, TX12.2015
No Degree - Phlebotomy
Kilgore College
Kilgore, TX04.2009
High School Diploma -
Elysian Fields High School
Elysian Fields, TX05.2008
Skills
- Documentation Management
- Compliance Requirements
- Quality Standards Adherence
- Random Sampling
- Quality Assurance and Control
- Manual Pricing
- Providing Performance Feedback
- Manually calculating and pricing claims
- Providing feedback for guideline/lock
- Experience in systems such as bluechip,premier,mpui,claim gui,CAT,CPA,Fss,Prap etc
Timeline
Quality Auditor
HCSC, Blue Cross Blue Shield Of Texas
03.2022 - Current
Sr Claims Technician
HCSC, Blue Cross Blue Shield Of Texas
02.2019 - 03.2022
Customer Service Advocate
HCSC, Blue Cross Blue Shield Of Texas
06.2014 - 02.2019
Phlebotomist
Clinical Pathology Laboratories, Inc.
12.2012 - 06.2014
Phlebotomist
Good Shepherd Medical Center
02.2010 - 11.2012
Associate of Science - Nursing
Tyler Junior College
No Degree - Emergency Medical Technology
Panola College
No Degree - Phlebotomy
Kilgore College
High School Diploma -
Elysian Fields High School