Ashton Lester
Quincy,IL
Summary
Professional Payment Integrity Associate with experience working with teams to accomplish short- and long-term project goals. Adept at planning, directing and maintaining continuous operations in various departments. While exceling through mentoring, training and empowering team to excel in performance.
Overview
14
14
years of professional experience
Work History
Payment Integrity Associate
Health Care Service Corporation
04.2022 - Current
- Identifies, researches, and resolves complex payment issues originating from vendor findings.
- Identifies, develops, and implements new concepts that will target claim overpayment scenarios
- Performs analysis on claims, provider data, enrollment data, medical policies, claim payment policies for payment integrity concepts for recovery opportunities.
- Applys thorough understanding of each line of business's specific procedures, to make recommendations to reduce and/or eliminate erroneous payment exposure with minimal direction.
Senior Claim Technician
Health Care Service Corporation
05.2020 - 04.2022
- Maintained knowledge of policies and procedures and insurance benefit contracts
- Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims
- Investigated and analyzed requirements to improve timeliness of claims
- Process Blue Chip errors with knowledge of contract administration, membership and inquiry processing, and medical terminology
General Manager
Thyme Square Bakery & Cafe
05.2009 - 05.2020
- Established clear performance goals and metrics for revenue, P&L, customer service and customer retention
- Enhanced operational performance by developing effective business strategies, testing new development, maintaining project plans and creating and communicating current system updates
- Participated in organizational transformation and implementation activities to monitor corporate restructures
Education
Bachelor of Science - Business
Culver-Stockton College
Canton, MO12.2018
Skills
- Word
- Excel
- PowerPoint
- Blue Chip
Timeline
Payment Integrity Associate
Health Care Service Corporation
04.2022 - Current
Senior Claim Technician
Health Care Service Corporation
05.2020 - 04.2022
General Manager
Thyme Square Bakery & Cafe
05.2009 - 05.2020
Bachelor of Science - Business
Culver-Stockton College