Ashley Roberts
Summary
Experienced Authorization Specialist with 5 years of experience in clinical office and corporate utilization management settings. Comprehensive understanding of the care spectrum and intricacies of the authorization processes. Dedicated, knowledgeable, and reliable professional with exceptional organizational skills. Committed to contributing to the team's success and helping achieve company goals.
Overview
8
8
years of professional experience
Work History
Authorization Specialist 2
Centene Corporation
Miami, FL
07.2022 - Current
- Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines
- Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
- Align authorization with guidelines to ensure timely adjudication for payment.
- Performs data entry to maintain and update various authorization requests into utilization management system
- Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer
- Remains up-to-date on healthcare, authorization processes, policies and procedures
- Performs other duties as assigned and complies with all policies and standards
- Authorization specialist trainer in all intake processes
- Provided training for authorization specialists, team leads and temporary staff.
- Works together with supervisor and managers to complete project and reach goals
- Fault census reports, error reports and Cloud processing
- Knowledgeable of all intake review department processes and guidelines
Patient Access Representative /Referral Coordinator
Optimal Health Medical Center
Miami Gardens, FL
03.2021 - 07.2022
- Reviewed each step of patient care and made proactive adjustments to avert issues.
- Built strong connections with patients and external partners.
- Enhanced preventative measures to minimize patient readmissions.
- Determined need for special assessment activities for complex cases, effectively handling care plans.
- Ensured adherence to confidentiality protocols.
- Worked with patients to schedule tests and procedures.
- Sent and handled electronic requests for new medications and medication refills.
- Assisted medical staff in building patient rapport.
- Managed over 50 calls per day.
Medical Office Receptionist
AssociatesMD
Plantation, FL
05.2020 - 08.2021
- Pulled charts and prepared for nurse and doctor assessment.
- Maintained patient databases and updated information in alignment with HIPAA protocols.
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
- Restocked each medical room with adequate supply of medications and supplies in preparation for patients.
- Used ECW to schedule appointments for doctor visits and procedures.
- Reviewed and sent medical records to other physicians upon request.
- Received, recorded and filed medical payments by check, cash and credit card.
- Encountered over 100 patients per day.
- Multi special practice with specialties ranging from; cardiology, endocrinology, primary care, vascular surgery, and podiatry.
Care Coordinator
Gastro Health
North Miami Beach, FL
08.2020 - 03.2021
- Updated policies and procedures, leading continuous improvement of resident assessments and care.
- Determined need for special assessment activities for complex cases, effectively handling care plans.
- Completed resident assessments in accordance with current regulations and guidelines.
- Used company software and databases to maintain records of services performed and patient conditions.
- Obtain lab results and pathology reports.
- Attends MIPs workflow trainings and proactively educates oneself on the documentation requirements needed for each measure.
- Maintains historical documentation of the process for collecting, compiling, submitting and timely filing
- Scheduled over 100 procedures per week.
Medical Office Receptionist
East/West Pediatrics, P.A.
Fort Lauderdale, FL
05.2017 - 05.2020
- Enhanced office productivity by handling high volume of callers per day.
- Greeted all visitors, employees, and families in person and on the phone in a positive and professional manner
- Maintained a system of controls for cash receipts, and daily reconciliation processes to ensure proper handling of monies received
- Verified patient insurance via phone or website and collect any necessary payment for services.
- Checked to ensure that patients fill out applicable forms completely and correctly.
- Demonstrated proper telephone etiquette when receiving transferring and placing calls on hold. Hold times are to be kept to a minimum.
- Managed over 100 calls per day.
Education
High School Diploma -
West Park Prep
West Park, FloridaSkills
- Communication
- Delegation
- Adaptability
- Problem solving
- Interdepartmental collaboration
- Organizational skills
- Verbal and written communication
- Multitasking ability
- Medical terminology
- Scheduling
- Microsoft office
Timeline
Authorization Specialist 2
Centene Corporation
07.2022 - Current
Patient Access Representative /Referral Coordinator
Optimal Health Medical Center
03.2021 - 07.2022
Care Coordinator
Gastro Health
08.2020 - 03.2021
Medical Office Receptionist
AssociatesMD
05.2020 - 08.2021
Medical Office Receptionist
East/West Pediatrics, P.A.
05.2017 - 05.2020
High School Diploma -
West Park Prep