Ashley Sommer
WA
Summary
Experienced Medical Biller with 11 years of expertise, seeking a Patient Support role. Demonstrated proficiency in claims processing, billing accuracy, and staff training. Skilled in medical coding, case assessments, and insurance verifications. I am a seasoned leader with a strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for a collaborative approach and unwavering commitment to excellence.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Insurance Billing Specialist
BabyList
11.2024 - Current
- Assisted patients in understanding their coverage benefits, providing clear explanations and addressing any concerns or questions.
- Reduced processing time with thorough pre-authorization requests, ensuring prompt approvals for patient procedures.
- Enhanced claim accuracy by meticulously reviewing and verifying patient insurance information.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Boosted revenue retention, adeptly negotiating with insurance companies on disputed claims.
- Assisted colleagues during peak workload periods, demonstrating strong teamwork and commitment to overall departmental success.
- Minimized errors in claims submissions through regular cross-checking of CPT and ICD codes against medical documentation.
Medical Biller Complex Claims, Training & Development
Crime Victims Compensation Labor and Industries
06.2018 - Current
- Ensure compliance with billing protocols and maintain accuracy in the submission of medical, mental health, and durable medical equipment claims
- Provider and Patient relations, advocating and educating all parties
- Ensured onboarding and training modules were maintained and perform quality assurance checks
- Account management for a caseload of over 100 claims, working one on one with insurance providers, medical providers and staff, advocating and educating medical professionals and patients
- Processed appeals from providers and claimants, often drafting personalized response letters regarding the appeals
- Train new staff in medical billing procedures to build a proficient team capable of managing complex billing operations
- Crafted trainings and created training binder for new hires
- Advocate on behalf of the patient regarding treatment and case guidelines as stated in legislative policies
- Ensure that proper insurance guidelines are met
Medical Biller and Coder
Labor and Industries Worker's Comp
06.2015 - 05.2018
- Reviewed and processed medical billing submissions, achieving accurate outcomes for payment determinations
- Conducted comprehensive initial phone interviews to compile critical information for case evaluations
- Precisely coded patient records, ensuring adherence to documentation standards and facilitating correct billing procedures
- Reviewing and educating on benefits administration and policies
- Working directly with patients, providers and insurance companies
- Reviewed and processed appeals, contacting reporting parties to discuss determination via phone or written communication
- Build trust and rapport between insurance companies, patients and providers, ensuring all needs are met and proposed treatment goes according to guidelines and legislative codes and policies
Education
Business Administration - Medical Billing and Coding
Kaplan College
01.2013
Skills
- ICD-9 & CPT Coding
- Referrals
- Pre-Authorizations
- Claim Submission
- Data Analysis
- Patient Collections
- Provider Credentialing
- Claims Processing
- Electronic Health Records Management
- Niko Billing Software
- Zendesk & Slack communications
- Availity, UMR/UHC, Humana and various other insurance provider portals
- Patient Intake
- Chat Support
- Data Entry
- Management
- Client Support
- AI model training
- Training and QA
- AI Writing prompts
Accomplishments
Experienced training professional having mentored and trained many individuals and new-hires. Developed and delivered training sessions on billing software, provider portal usage, and best practices. Trained and mentored new team members on insurance billing processes, claims submission, and eligibility verification.
Certification
- Medical Office Administration, Kaplan College
- Medical Billing and Coding, Kaplan College
Timeline
Insurance Billing Specialist
BabyList
11.2024 - Current
Medical Biller Complex Claims, Training & Development
Crime Victims Compensation Labor and Industries
06.2018 - Current
Medical Biller and Coder
Labor and Industries Worker's Comp
06.2015 - 05.2018
Business Administration - Medical Billing and Coding
Kaplan College
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