Summary
Work History
Education
Skills
Timeline
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ASHLEY WATKINS

South Salt Lake, UT

Summary

Detail-oriented Customer Service Coordinator with strong communication and organizational skills, experienced in coordinating service operations, resolving customer concerns, and supporting cross-functional teams. Proven ability to manage high-volume inquiries, maintain accurate records, and improve customer satisfaction through efficient processes and positive client relationships.

Work History

Health Benefits Specialist

Select Health
Murray, UT
  • Enhanced overall service delivery by effectively handling incoming calls from various stakeholders, including members, providers, and employer groups.
  • Facilitated customer satisfaction by addressing issues on first contact and managing follow-up communications for intricate inquiries.
  • Oversaw compliance with auditing standards through the establishment of comprehensive review processes. Fostered knowledge enhancement in general plan design and modifications to improve information accuracy.
  • Led initiatives to safeguard member information, ensuring alignment with confidentiality standards. Enhanced tracking systems by implementing precise coding and providing in-depth analysis of customer histories.
  • Directed educational initiatives for callers regarding plan usage, benefits coverage, and administrative protocols. Collaborated with cross-functional teams to optimize operational efficiency. Exercised decision-making authority within exception policies to empower team responses.
  • Adhered to established protocols to ensure timely completion of pre-notifications and pre-certifications for members and providers.
  • Monitored claims processing accuracy, implementing corrective actions to reduce errors and improve turnaround times.

Customer Advocate Specialist

University of Utah Health Plans
MURRAY, UT
  • Monitored and enforced customer service performance expectations to enhance service quality.
  • Facilitated understanding of claims adjudication to ensure accurate allocation of deductibles, co-pays, co-insurance maximums, and provider reimbursements.
  • Facilitated effective communication with members, providers, and insurance entities to address inquiries related to claims, benefits, and eligibility.
  • Monitored and documented phone calls in EHR systems, addressing issues as necessary to enhance patient care.
  • Facilitated resolution of problems stemming from claim adjudication and customer service interactions to enhance client satisfaction.
  • Managed email correspondence to address customer service inquiries and enhance client satisfaction.
  • Utilized CRM systems to track interactions and improve service delivery

Prior Authorization Representative

Intermountain Health
Murray, UT
  • Coordinated interactions with patients and healthcare professionals to obtain required authorizations for services.
  • Collaborated with insurance payers to deliver critical information for pre-authorization requirements.
  • Inputted critical admission data to facilitate accurate billing, reporting, and analysis for facility, corporate, state, and federal agencies.
  • Delivered comprehensive explanations of legal documents to enhance customer understanding and adherence to regulations.

Patient Service Representative

Sutter Health
WEST VALLEY CITY, UT
  • Facilitated efficient patient registration by ensuring accurate verification of demographic details and insurance coverage in compliance with departmental policies.
  • Coordinated scheduling of patient appointments to ensure timely consultations, evaluations, and follow-ups.
  • Recorded and organized patient medical information and communications to ensure comprehensive care.
  • Safeguarded protected health information, adhering to HIPAA regulations to protect patient privacy.
  • Provided exceptional customer service by addressing patient inquiries and resolving issues efficiently.

Customer Service Representative

Molina Healthcare
Midvale, UT
  • Facilitated effective communication by handling and recording inbound pharmacy calls to ensure accurate information exchange.
  • Managed pharmacy prior authorization requests and appeals to ensure timely approvals and enhance patient care.
  • Communicated essential information regarding point of sale claims adjudication and CMS policy to ensure compliance among providers, members, and pharmacies.
  • Supported administrative functions and routine operations to enhance workflow efficiency.
  • Delivered comprehensive plan benefit information to enhance understanding of formulary options, copay structures, pharmacy services, and prior authorization processes.
  • Supported members and providers in navigating the process of initiating oral and written coverage determinations and appeals.
  • Monitored and upheld specific quality and quantity benchmarks to support operational excellence.
  • Provided exceptional customer support via phone, email, and chat to resolve inquiries effectively.

Customer Service Representative

United Healthcare Group/Optum
SALT LAKE CITY, UT
  • Engaged with pharmacies to enhance transaction processing efficiency and address any processing challenges.
  • Updated stakeholders on educational progress and authorization request statuses to ensure informed decision-making.
  • Managed pharmacy inquiries and concerns to ensure timely resolution of claims.
  • Investigated intricate pharmacy issues utilizing various databases and coordinated with support teams to address escalated concerns.

Customer Advocate Specialist - Endoscopy

U OF U HOSPITAL & CLINICS
SLC, UT
  • Coordinated patient scheduling and operator service functions through effective handling of inbound and outbound calls.
  • Coordinated and verified accurate information exchange among medical staff, hospital staff, and multiple departments to support patient care.
  • Undertook administrative and clerical projects to support departmental objectives.

Enhanced Imaging Scheduler

Intermountain Health
Murray, UT
  • Coordinated outreach to patients for scheduling and registration purposes.
  • Coordinated efforts with medical personnel and associates to streamline scheduling processes and improve operational effectiveness.
  • Gathered and recorded comprehensive demographic and financial information, including insurance details, to ensure accurate patient records.
  • Provided comprehensive education to patients regarding imaging exams and necessary preparation steps.

Provider Services

Sutter Health
Murray, UT
  • Coordinated interactions with healthcare providers and insurance representatives to ensure timely updates on claims authorizations and eligibility.
  • Addressed medical billing and insurance questions to enhance patient understanding.
  • Conducted thorough research on CPT and ICD-9 coding discrepancies to support compliance initiatives and optimize reimbursement processes.
  • Assessed and confirmed eligibility for benefits to ensure compliance with regulations.
  • Developed and implemented training programs to enhance employee skills and productivity.

Customer Service Specialist

CVS Caremark Pharmacy
SALT LAKE CITY, UT
  • Educated providers, members, and pharmacies on point of sale claims adjudication requirements and state CMS policy compliance.
  • Conveyed comprehensive plan benefit information to enhance understanding of formulary details, copay structures, pharmacy services, and prior authorization requirements.
  • Motivated team members to align efforts with company goals, ensuring objectives were met.
  • Acquired payment information and relevant customer data, such as addresses and phone numbers, to ensure accurate order placement.
  • Addressed customer grievances promptly, utilizing targeted strategies to improve overall experience.
  • Enhanced customer experience by resolving issues on the first call, leading to elevated satisfaction ratings.

Education

High School Diploma -

SLCC

Skills

  • Proficient in organization
  • Experienced with MS Office applications
  • Effective communicator
  • Strong ability to resolve complex issues
  • Skilled in prioritizing concurrent responsibilities
  • Detail-oriented professional
  • Client relationship management
  • Proficient in clear verbal and written expression

Timeline

Health Benefits Specialist

Select Health

Customer Advocate Specialist

University of Utah Health Plans

Prior Authorization Representative

Intermountain Health

Patient Service Representative

Sutter Health

Customer Service Representative

Molina Healthcare

Customer Service Representative

United Healthcare Group/Optum

Customer Advocate Specialist - Endoscopy

U OF U HOSPITAL & CLINICS

Enhanced Imaging Scheduler

Intermountain Health

Provider Services

Sutter Health

Customer Service Specialist

CVS Caremark Pharmacy

High School Diploma -

SLCC

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ASHLEY WATKINS