ASHLI KEENAN
TAMPA,FL
Summary
To obtain a position within a company that will allow me to utilize my skills and knowledge.
- 14+ years as a clinical professional with experience of Medical Claims, Enrollments, and Insurance Verification, Provider Credentialing & Provider Maintenance.
- Medicaid and Medicare Advantage Plans Experience
- Managed Care Experience
- Ensures high quality and individualized patient and member care
- Ability to transfer patient information into electronic medical records
- Strong Data Entry and Microsoft Office Suite: Word, PowerPoint, Excel knowledge
- 45 WPM
Pragmatic Insurance Verification Specialist touting 10 years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.
Overview
14
14
years of professional experience
Work History
INSURANCE VERIFICATION SPECIALIST
SHARED SERVICES
01.2023 - 05.2023
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process
- Assured timely verification of insurance benefits prior to patient procedures or appointments
- Updated patient records with accurate, current insurance policy information
- Made contact with insurance carriers to discuss policies and individual patient benefits
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations
- Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures
- Responsible for obtaining verification of patient payer benefits and eligibility for the homecare services ordered
- Includes Private Insurance, Veterans Association, Medicare/Medicaid
- Ensures that cases are effectively managed according to utilization and authorization, as defined by the payer
- This function includes: documentation and ongoing maintenance of authorization and reauthorization
- Input patient demographics, insurance information and doctor.
SENIOR CREDENTIALING SPECIALIST
WELLSTAR
09.2018 - 11.2022
- Responsible for verifying the professional licenses and certifications of medical staff
- Execute applications and track the process for new State medical licenses for providers
- Prepare and submit all appropriate applications and required supporting documentation
- Follow-up with insurance companies to ensure timely processing of applications and contracts
- Worked within a specialized team to maintain provider profiles for over a thousand healthcare providers, as well as new enrollments for healthcare providers new to the system
- Communicates with providers by phone, fax, email, and mail regarding credentialing status and information
- Conducts review of provider credentialing, to include all aspects of new applicant credentialing, re-credentialing and ongoing maintenance of provider credentials
- Performs online verifications, administrative support of credentialing functions and oversight of contracted Certified Verification Organization
- Provides support for the department through coordination, monitoring, tracking and reporting information on a daily, weekly, and monthly basis.
- Identifies, researches, and resolves issues on NPI Data to ensure prompt claim payment and matching logic including making calls to provider offices.
- Worked with Team and internal counterparts to ensure NPI data is loaded correctly in system for all Provider types.
- manage constantly changing priorities, work independently and assess and evaluate provider data across systems and NPI types.
BILLING & ENROLLMENT SPECIALIST
CAREPLUS/ HUMANA
01.2015 - 08.2016
- Provide sales agents with prospects Medicaid and Medicare eligibility
- Provide knowledge about Medicare and Medicaid
- Order marketing supplies for sale agents
- Help prospects sign up for extra help such as LIS and Medicaid through DCF
- Checked member enrollment status, Checked agent license status
- Did miscellaneous office work; talked on phones, sort mail, fax, make copies, scan and distribute work
- Discussed and processed claims and billing
- Changed addresses, phone numbers, email, PCP'S and security questions in CSC system.
RECONCILIATION ANALYST
HEALTH PLAN SERVICES
07.2014 - 12.2014
- Review, monitor, prepare and reconcile contract documents
- Comparing records between two institutions to find discrepancies
- Create member and correct members files in company database
- Schedule shipment and delivery of patient's medication
- Provide insurance benefits and coverage information
- Process payments for medication
- Answer questions about copay, deductibles and out of pocket expenses
- Reached out to providers office for new prescriptions and Prior authorizations
- Enter new prescriptions into database for Pharmacist to finalize and fill.
PATIENT CARE ADVOCATE
MEDCO/ EXPRESS SCRIPTS
08.2011 - 05.2014
- Place outgoing calls to potential customers & offer them a cruise package
- Receive incoming calls and book cruise for the customer
- Upsell cruise packages
- Made quota of 5 cruise sells every week
- Made outbound calls to potential customers to sell cruise packages
- Received inbound calls from customers to buy or set up cruise vacation
- Did survey calls to see how cruise experience was.
SALES REP
CARIBBEAN CRUISE LINE
01.2010 - 01.2011
- Responsibilities were to review & process medical claims accurately from medical facilities.
CLAIMS SPECIALIST
CSSI BILLING SOLUTIONS
03.2009 - 01.2010
- Proficiency with Microsoft Office including Word, Excel, Access and PowerPoint
- Review, monitor, prepare and reconcile contract documents
- Comparing records between two institutions to find discrepancies
- Create member and correct members files in company database
- Schedule shipment and delivery of patient's medication
- Provide insurance benefits and coverage information
- Process payments for medication
- Answer questions about copay, deductibles and out of pocket expenses
- Reached out to providers office for new prescriptions and Prior authorizations
- Enter new prescriptions into database for Pharmacist to finalize and fill.
Education
Associate of Arts - Medical Billing & Coding
Herzing University
Dearborn, MI08.2024
High School Diploma -
CHAMBERLAIN HIGH SCHOOL
Tampa, FL05.2006
Skills
- Problem solving skills/ Analytical Skills
- Leadership skills
- Can work in team setting
- Ability to Adapt to Change
- Fast Learner
- Critical thinking skills
- Great communication skills(Written & Oral)
- Great Organization Skills
- Computer Software and Application knowledge
- Years of great Customer Service Skills
- Attention to Detail
- Electronic Medical Records
Timeline
INSURANCE VERIFICATION SPECIALIST
SHARED SERVICES
01.2023 - 05.2023
SENIOR CREDENTIALING SPECIALIST
WELLSTAR
09.2018 - 11.2022
BILLING & ENROLLMENT SPECIALIST
CAREPLUS/ HUMANA
01.2015 - 08.2016
RECONCILIATION ANALYST
HEALTH PLAN SERVICES
07.2014 - 12.2014
PATIENT CARE ADVOCATE
MEDCO/ EXPRESS SCRIPTS
08.2011 - 05.2014
SALES REP
CARIBBEAN CRUISE LINE
01.2010 - 01.2011
CLAIMS SPECIALIST
CSSI BILLING SOLUTIONS
03.2009 - 01.2010
Associate of Arts - Medical Billing & Coding
Herzing University
High School Diploma -
CHAMBERLAIN HIGH SCHOOL
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