Ashley Suarez

• Ensures compliance with the MN Hospital Screening Bill. Responsible to process the Hospital Presumptive Eligibility applications and complete affidavit of expert review prior to referral of debt to a collection agency, law firm or any legal collection action.
• Reviews Hospital Presumptive Eligibility (HPE) applications.
• Completes HPE approval process.
• Reviews information for accuracy.
  Provides accurate information to the patient, third-parties (inclusive of law firms and collection agencies).
• Reviews and analyzes account activity and payers explanations of benefits (EOB).
• Verifies payments and adjustments are received and applied accurately.
• Ensures self-pay collection process is completed appropriately.
• Completes expert review prior to account referral to a collection agency or law firm.
  Completes expert review prior to legal actions.
• Other duties as assigned.
• Reduced errors in eligibility determinations by maintaining thorough knowledge of program guidelines and regulations.
• Ensured compliance with state regulations during all phases of the eligibility determination process.

• Enrolls providers with contracted health plans using various electronic enrollment applications and keeping track in Provider Enrollment Credentialing Database
• Submit Provider Enrollment Health Plan Approval documentation into credentialing system
• Reconcile Provider Enrollment databases to ensure record accuracy including directory updates
• Complete appropriate steps for updating and maintaining Provider Enrollment Databases and to ensure claims processed timely and accurately
• Handle the credentialing process for individual providers
• Request and update expireables for individual providers
• Ensure all work is performed according to established policies and guidelines
• Frequent provider interaction to ensure timely 3rd party payer enrollment is completed
• Receive and initiate calls to 3rd party payers, answer an ACD call system, respond to internal and external customer questions and requests for resolution
• Enters and reconciles individual providers and/or organization data
• Resolves and responds to internal and external customer inquiries
• Completes enrollment applications for agencies
• Manages internal documentation in OnBase
• Handles Revenue Cycle Management issues
• Ensures providers are set-up in the billing system
• Out of State Medicaid Emergency Room Enrollments
• Verify billing hospital claim for accuracy with enrollment request
• Received and evaluated applications to look for missing and inaccurate information.
• Update Enrollment records for all hospitals and clinics in (MPSE) with Minnesota Health Care
  Programs
  (MHCP)
• Review of electronic health records and obtain medical records for enrollment request.
• Streamlined the provider enrollment process by effectively managing and prioritizing tasks.
• Contributed to the successful onboarding of new providers by guiding them through the enrollment process.
• Coordinated with cross-functional teams for seamless integration of new providers into existing systems.
• Maintained comprehensive records of enrolled providers, enabling easy access to information for internal stakeholders.
• Reduced errors in provider information by conducting regular audits and updating records as needed.
• Expedited the resolution of discrepancies or missing information through diligent follow-ups with providers or other stakeholders involved in the process.
• Ensured data integrity by adhering to strict confidentiality regulations surrounding patient information and HIPAA compliance.

• Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes
• Ensured data integrity by adhering to strict confidentiality regulations surrounding patient information and HIPAA compliance.
• Initiates and obtains prior authorizations from insurance companies
• Train new employees
• Provides administrative support for UM processes such as triages telephone requests from payers for information, notification or follow up, organization of daily census related to admissions and discharges
• Processes or obtains authorizations/certifications based on payer contracts
• Certifications/notifications to payers of hospital admissions, treatments and/or procedures are completed timely and within payer required timeframes
• Places call backs to health plans per their request, refers cases requiring clinical input to the UM Specialist or Clinical Case Manager as appropriate
• Promotes cohesiveness and peer support among department staff and colleagues
• Acts as a resource to others to assure department tasks are completed timely
• Utilizes strong interpersonal communication skills and effective conflict resolution skills to foster mutually respectful and cooperative working relationships
• Keeps supervisor advised of problems, ideas or decisions
• Medical records review to ensure coding is accurate for scheduled surgeries for non-Allina clinics
• Claim denial resolution
• Conducted in-depth analysis of denied claims and composed appeal letters for patients.
• Identify coding any discrepancies with Allina clinics to ensure accuracy for scheduled surgeries
• Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
• Assisted in revenue cycle optimization efforts through comprehensive analysis of denied claims, pinpointing root causes, and recommending corrective actions.
• Built relationships with industry stakeholders to stay informed on industry trends and developments

• Observe and report new trends from payors
• Streamlined claim submission process for faster turnaround times and reimbursement rates.
• Collaborated with medical staff to obtain necessary documentation for accurate claim submissions.
• Provided exceptional customer service, assisting patients in understanding their insurance benefits and financial responsibilities.
• Aided in boosting revenue by identifying opportunities for additional reimbursements through audits of past claims.
• Follows and reports status of delinquent accounts
• Credentialing providers
• Performs various collection actions including correcting and resubmitting claims to third party claims
• Prior authorizations
• Review medical records
• Communicated effectively with staff members of operations, finance and clinical departments
• Achieved timely resolution of claim issues through effective communication with insurance carriers and healthcare providers.
• Investigated insurance claims denials and composed appeal letters
• Filed and tracked insurance claims and communicated claims status to patients
• Followed up on unpaid insurance claims, outstanding customer balances and other financial discrepancies
• Established relationships with clients and insurance companies to foster timely claims resolution
• Consistently exceeded performance benchmarks, processing a high volume of claims accurately within designated timeframes.
• Served as a reliable resource for colleagues, sharing expertise on industry trends, changes in coding practices, or updates to payer requirements as needed.
• Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and other applicable regulations in all aspects of the role.

• Prior authorizations
• Maintain a working knowledge of health care plan requirements and health plan networks
• Ensure appropriate forms are used when requesting adjustments, insurance transfers or other specific account changes
• Prepare, submit and ensure timely clean claim accuracy for all physician billing to third party insurance
• Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
• Enhanced data integrity by implementing strict quality control measures on all billable items entered into the system.
• Following up on unpaid, denied or rejected claims
• Review and work any credit balances to determine if patient and/or insurance company refund is applicable
• Consult with Physician to ensure medical record notes are completed to ensure timely billing
• Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
• Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments
• Audited and corrected billing and posting documents for accuracy
• Utilized various software programs to process customer payments
• Provided excellent customer service, developing and maintaining client relationships

• Monitoring the in-clinic and outside collection agency activities through the posting and reconciliation of payments through the practice management system
• Administer accounts receivable functions including billing for product and services, entering payments from patients, reconciling daily monies received
• Administer accounts payable duties including but not limited to reconciling monthly statements with invoices, & tracking of pending credits
• Posting insurance/patient payments that have been received via check, EFT, credit card or cash
• Assisting with pre-verification of insurance benefits through an electronic eligibility portal
• Respond to inquiries concerning account balances, third party payments from patients and other payers respectfully and in a timely manner
• Maintain appropriate files and records to effectively monitor, track and process payment plans
• Keeping up to date on provider bulletins from payers and updating the Business Office Supervisor on changes needed in workflows to allow for the successful processing of claims
• Independently prioritize workload to optimize workflows pertaining to payment/claims processing
• Resolve conflicts pertaining to outstanding balances with consumers
• Created new medical records and retrieved existing medical records by gathering appropriate record folders and contents and assigning and recording new record numbers.
• Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
• Utilized Electronic Medical Records (EMR) systems to record patient data.

• Provided the highest level of service to all customers who include policy holders, claimants, agents, loss control, underwriting, peers and in-house telephone claims representatives
• Dispatch all injury claims accordingly and monitor
• Gathers supporting data including loss scope, appraisals, interviews, police reports, and statements related to the claim
• Provided exceptional customer service to diverse clientele, fostering an atmosphere of inclusivity and respect.
• Enhanced customer satisfaction by promptly addressing concerns and providing accurate claim information.
• Supported continuous improvement efforts by identifying opportunities for process enhancements in the claims handling process.

• Determined estimates on vehicle damage and repair through comparison and evaluation of different methodologies
• Vendor Management
• Review facts of matter and ensured all claims featured only related damages
• Counseled customers on repair plans
• Worked with customers on negotiation and plans for cost of up-sell items
• Evaluated and approved repair orders with technicians
• Data entry

(Office of the State Surgeon)

• Responsible for tracking medical status of ALL assigned Soldiers, in accordance with DoD, NGB, and
• State guidelines in reference to type of follow up, timelines, dispositions and all other guidance set forth in policy
• Attend soldier readiness process/reverse soldier readiness process (SRP/RSRP) events and perform detailed records review of individual soldiers to identify any medical/dental concerns that require correction to maintain a deployable status
• Ensure all medical documentation received from the Soldier and/or their medical team is received and placed in appropriated electronic record
• Review medical packets to include MEBs, LODS, INCAP, RCMC, etc for accuracy and advise units on corrective actions if needed
• Maintain Soldier medical records in accordance with Army Regulation (AR) 40-66
• Provide medical officer and/or MEB coordinator or delegate with all relevant medical/dental documentation to make informed decisions on Soldiers care he/she is being profiled for in an organized fashion
• Obtain release of information from Soldier
• Track medical appointments by communication with unit to ensure Soldier attendance and submission of follow up documentation
• Correctly document care in MODS
• Run MEDPROS report pre/Post PHA/SRP event
• Monitor MEDPROS to ensure all scheduled services are completed/updated and current medical status is reflected
• Report Medical Readiness updates to case manager as needed and/or requested
• Upload and index medical documents of case managed Soldiers into Health Readiness Record (HRR)
• MODS entry of immunizations, designation of pregnancy, eye exams, medical warning tags
• Performs on site Mobilization Station Assistance visits for units of the MN-ARNG to facilitate processing through the SRP at the mobilization station as well as maintain a deployable status at all times
• Develops and maintains local mobilization medical readiness information databases and spreadsheets to provide weekly status reports to units and State Surgeon’s Office
• Coordinate referrals for soldiers to address all components of a fully medical ready and resilient Soldier to include the psychological, family, social, spiritual, and emotional support programs available to service members (SM) using 4.19 Develop and maintain positive relationships at multiple levels within the MN-
• ARNG, including both Army and Air National Guard
• Works with MTF, Tri-Care and the Military Medical Support Office (MMSO) to obtain prior authorization for treatment
• Coordinates with the SM to ensure all appointment dates and times are accurate
• Provide technical expertise to Medical Readiness NCO’s toward identifying, evaluating, resourcing, monitoring, and determining dispositions for service members with medical issues and/or medical actions to include MEBs, PEBs, INCAP, LODSs, RCMC, etc
• Utilize ICD-10 codes for data entry