Ashley F Koya
Azle,TX
Summary
Dedicated employee with 15 years of healthcare knowledge and experience. Known for punctuality, politeness, and professionalism pursuing employment options where good customer service and positive attitude will make a difference. Attentive and compassionate about patient care with calm and organized approach to stressful or fast paced healthcare environments. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
16
16
years of professional experience
Work History
Behavioral Health Outreach Care Specialist
Elevance
REMOTE
03.2023 - Current
- Provided crisis intervention services to individuals in need of immediate assistance.
- Assisted clients in identifying resources to meet their physical, emotional, and financial needs.
- Coordinated referrals to other community-based programs such as housing or employment services.
- Organized educational workshops on topics related to substance abuse prevention or mental health awareness.
- Compiled relevant clinical data into reports for review by supervisors or administrators.
- Advised family members about available resources for providing support to their loved ones with mental illness.
- Maintained accurate documentation of all client activities in accordance with state regulations.
- Provided guidance and counseling to individuals struggling with addiction or depression.
- Assessed risk factors associated with suicide attempts or self-harm behaviors among clients.
- Educated clients on healthy coping strategies for managing stress or anxiety levels effectively.
- Participated in team meetings regarding case management strategies and outcomes assessment.
- Followed up with previous clients after discharge from program to monitor progress over time.
Health Information Specialist II
CIOX HEALTH, Health Information Managment
Remote
01.2020 - Current
- Facilitated document import into electronic health records using variety of applications and workflows, executed scanning and indexing and organized patient records for quick reference.
- Process HIPPA compliant medical record authorizations
- Addressed customer information requests promptly and courteously, maintained strict confidentiality and respect and identified potential improvements to inquiry response processes.
- Pulled patient charts for upcoming appointments.
- Maintained complete confidentiality in accordance with organization and legal requirements.
- Observed confidentiality and safeguarded all patient-related information.
- Worked with multiple EMR & EHR systems including but not limited to EPIC/NEXGEN/ATHENA
- Process yearly medical audit requests from CMS/DRG/BCBS/PAYD,PAYI/CDC/RSK ADJUSTMENT
- Process record requests from ATTY/GOV/INS/PATIENT/CLINICS
- Reviewed Medical Records for specific CPT/ICD 10/ AND HCPCS codes
Utilization Management Representative III - REMOTE
Elevance
REMOTE
07.2022 - 03.2023
- Applied abilities in techniques like active listening and collaborative problem-solving to make positive impact.
- Working with 988 suicide prevention department within anthem health
- Developed safety plans to minimize crisis risk and intervene with specific procedures.
- Assessed risk to client, loved ones or general public through established evaluation procedures.
- Helping callers and texters to trust hotlines by providing individualized and caring support.
- Responding to emergency situations and provided crisis support.
- Referred individuals to outside resources and services for additional support.
- Responded to crisis situations when severe mental health and behavioral issues arose.
- Completed detailed documentation of sessions, patient notes and recommendations.
- contacting emergency services in immediate crisis situations for chatters.
Patient Access Coordinator
The West Cancer Center
Germantown, TN
02.2019 - 12.2019
- Perform other duties and tasks as requested by Manager/Supervisor to ensure the efficient overall performance of the Access Center
- Follow HIPAA guidelines for the management of patient privacy and confidentiality.
- Obtain and verify patient demographic & fiscal information
- Followed up with insurance carriers regarding authorizations and referrals related to chemo treatments.
- Greet patients in a warm, welcoming and respectful manner
- Schedule appointments for new and returning patients.
- Performs duties in accordance with departmental guidelines
- Performed daily on EMR & EHR systems.
- Assist office in denial or claim payments
- Followed up with insurance companies in regards to improper payment of claims/ underpayments.
Utilization Review Specialist
Methodist Hospital Healthcare System
Richardson, TX
07.2017 - 01.2019
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
- Kept detailed documentation on all utilization reviews by using EPIC.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
Provider Administration Representative
Superior Medical Management
Dallas, TX
12.2014 - 07.2017
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Assisted in creating and issuing out claim appeals to insurance providers for non payments.
- Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email.
- Prepare documents necessary for issuance of provider numbers for physicians, physician assistants, and nurse practitioners.
- Follow-up with provider for missing billing paperwork and document the system.
- Provide functional support to the Provider Enrollment Support Team within the Operations Support Department.
- Posted charges, payments and adjustments.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Completed appeals and filed and submitted claims.
- Posted and adjusted payments from insurance companies.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Applied payments, adjustments and denials into medical manager system.
- Submitted refund requests for claims paid in error.
- Collaborated closely with other departments to resolve claims issues.
- Consistently informed patients of financial responsibilities prior to services being rendered.
- Precisely completed appropriate paperwork and system entry regarding claims.
- Analyzed and interpreted patient medical and surgical records to determine billable services.
Claims Customer Service Representative
North Texas Specialty Physicians
Fort Worth, TX
02.2014 - 11.2014
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Reviewed claims for accuracy before submitting for billing.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Sent clinical request and missing information letters to obtain incomplete information.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Corresponded with insurance customers and agents to obtain or relay information on account status changes.
Lead Customer Service Representative
Valence Health Insurance System
Bedford, TX
01.2012 - 02.2014
- Fielded inbound calls from customers inquiring about alternative insurance options to generate sales opportunities.
- Processed changes in insurance policies and periodically reassessed client needs.
- Calculated premiums and established payment methods.
- Coordinated enrollment into plan benefits directly with insurance companies or through marketplace.
- Offered patients information and assistance navigating insurance coverage.
- Explained coverage options to potential policyholders, answering questions or concerns.
- Received underwriting approvals after accurately completing applications for insurance coverage.
- Provided patients benefits/copays/ded/coin/premiums
Medical Records Auditor - Contract - Remote
Quadramed Corporation
Plano, TX
02.2011 - 12.2011
- Safeguarded patient records, managing data transfers in compliance with HIPAA standards and organizational regulations.
- Consolidated diverse medical records.
- Obtained information by contacting appropriate personnel or patients.
- Scanned and validated medical records for upload.
- Organized patient charts, gathering medical histories, lab results and consents.
- Purged inactive files and destroyed obsolete files following procedures.
- Worked with multiple hospital EMR systems to clean du
- Provided respectful assistance to patients, staff members and insurance company representatives.
- Entered patient insurance, demographic and health information into software and confirmed records.
- Scanned incoming documentation.
- Retrieved medical charts for healthcare staff for filing in medical records.
Medical Office Receptionist
Atlas Chiropractic
Dallas, Tx
06.2009 - 05.2011
- Organized paperwork such as charts and reports for office and patient needs.
- Scheduled, rescheduled and handled cancelled appointments for patients.
- Promptly answered multi-line phone system and greeted callers enthusiastically.
- Compiled physical and digital paperwork to meet business and patient needs, including charts, reports and correspondence.
- Interviewed patients to collect medical information and insurance details.
- Registered patients and scheduled appointments.
- Coordinated patient appointments, maintained files and received incoming phone calls.
- Submitted diagnosis and procedure codes for insurance companies.
Bank Teller - Part Time
Wells Fargo Bank
Desoto, TX
03.2008 - 06.2009
- Promoted products or services to each customer to consistently achieve sales targets.
- Assisted customers with setting up or closing accounts, completing loan applications and signing up for new services.
- Monitored customer behaviors and upheld strict protocols to prevent theft of assets.
- Verified amounts and integrity of every check or funds transfer.
- Maintained optimal financial controls by securing funds and making accurate transactions.
- Promoted facility security by monitoring customer behaviors and following established protocols to protect individuals and assets.
- Met or exceeded sales goals by promoting bank products and services in every interaction.
Education
High School Diploma -
Juan Seguin High School
Arlington,Tx5 2011
Skills
- Detailed & Proficient
- Behavioral Health
- Discharge Planning
- Extremely Knowledgeable in Healthcare/Health Insurance
- Over 10 Years of Healthcare & Customer Service Experience
- Knowledgeable in Medical Claims, Insurance R/A, EOBS, and Revenue Cycle Process
- Highly Qualified in Medical Records & Release of Information
- Extensive experience with healthcare EMR'S & EHR'S
- Proficient multi-tasker
- Safety planning
- Mental health support
- Suicide prevention professional
- HIP knowledge
- Caring and Empathetic
- Data Entry
- Active Listening
- Written Communication
- Task Prioritization
Timeline
Behavioral Health Outreach Care Specialist
Elevance
03.2023 - Current
Utilization Management Representative III - REMOTE
Elevance
07.2022 - 03.2023
Health Information Specialist II
CIOX HEALTH, Health Information Managment
01.2020 - Current
Patient Access Coordinator
The West Cancer Center
02.2019 - 12.2019
Utilization Review Specialist
Methodist Hospital Healthcare System
07.2017 - 01.2019
Provider Administration Representative
Superior Medical Management
12.2014 - 07.2017
Claims Customer Service Representative
North Texas Specialty Physicians
02.2014 - 11.2014
Lead Customer Service Representative
Valence Health Insurance System
01.2012 - 02.2014
Medical Records Auditor - Contract - Remote
Quadramed Corporation
02.2011 - 12.2011
Medical Office Receptionist
Atlas Chiropractic
06.2009 - 05.2011
Bank Teller - Part Time
Wells Fargo Bank
03.2008 - 06.2009
High School Diploma -
Juan Seguin High School
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