Ashley Gamez
Pico Rivera,CA
Summary
Senior Insurance Verification Specialist in insurance coverage analysis, customer service, and process optimization. Proven expertise in resolving claims and improving KPI metrics, delivering outstanding service in remote and onsite environments.
Offering strong analytical abilities and dedication to learning and development in insurance verification environment. Brings solid understanding of administrative processes and accuracy in data entry, with ability to quickly grasp new systems and procedures. Ready to use and develop skills in communication and problem-solving.
Overview
13
13
years of professional experience
Work History
Financial Clearance Specialist
City of Hope
02.2025 - 08.2025
- Identified insurance companies requiring prior authorization for services and obtain authorizations.
- Coordinate authorizations for procedures and testing requested by providers for their managed care patient.
- Contact patients, payers, or other departments to confirm and verify insurance and demographic information. Refers patients to financial counselors to resolve insurance or payments issues.
- Identified and resolved issues by working with patients, payors, and/or other CoH departments and personnel in a single interaction with the patient.
- Notified CoH contracting department of patients with a non-contracted insurance to prepare a Letter of Agreement (LOA) should patient to pursue services at COH and informs patient of approval status.
- Managed clearance processes for sensitive materials ensuring compliance with federal regulations.
- Developed and implemented training programs for new staff on clearance protocols.
- Coordinated documentation reviews to enhance accuracy in clearance submissions.
- Streamlined workflows to improve efficiency in processing clearance requests.
Senior Insurance Verification Specialist
Byram Healthcare
08.2016 - 02.2025
- Maintained 98% accuracy while verifying 80-100 insurance accounts daily, reducing claim errors by 20%
- Analyzed trends in denials and successfully submitted retro authorizations and appeals, achieving a 90% success rate
- Responded to grievances with comprehensive documentation to maintain contract compliance
- Collaborated with internal teams and external stakeholders to secure necessary medical documentation
- Consistently exceeded KPI targets, including quality assurance, productivity, and denial success rates
- Advanced from entry-level customer service to senior specialist within six years due to exemplary performance
Customer Service Representative
Animal Supply Company
12.2012 - 06.2015
- Coordinated daily delivery schedules, ensuring 100% on-time performance for client orders
- Communicated with customers to resolve issues, resulting in a 95% customer satisfaction rate
- Optimized inventory processes, reducing discrepancies by 15% through accurate system updates
- Supported cross-functional teams by providing timely updates on customer and delivery details
Education
High School Diploma -
El Monte Rosemead Adult School
Skills
- Insurance Verification (PPO/HMO, Medicare/Medicaid/CCS)
- Authorization/Referral Management
- Reporting & Data Analysis (Excel, Microsoft 365)
- Payor Portal Navigation (Availity, Noridian, Waystar)
- Claims Resolution & Appeals
- HIPAA Compliance & Cybersecurity
- Excel (Advanced Reporting)
- Medical Billing/Coding ICD-10, HCPCS
Timeline
Financial Clearance Specialist
City of Hope
02.2025 - 08.2025
Senior Insurance Verification Specialist
Byram Healthcare
08.2016 - 02.2025
Customer Service Representative
Animal Supply Company
12.2012 - 06.2015
High School Diploma -
El Monte Rosemead Adult School