Summary
Overview
Work History
Education
Skills
Timeline
Generic

Ashley Whitley

Pittsburgh

Summary

Organized and dependable individual successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

19
19
years of professional experience

Work History

Authorization Specialist

UPMC Magee
01.2020 - Current
  • Explains eligibility details and affordability options to patients with kindness and respect.
  • Request price estimates for patients to clarify, patient benefits, and out-of-pocket costs, helping them make informed decisions about their genetic testing.
  • Responds to patient inquiries and concerns and escalates complex problems to department supervisors.
  • Participates in new hire training and development tasks.
  • Create standard operating procedures and delivered training to credit personnel to improve operational efficiency.
  • Transcribes health insurance data from the EMR system to spreadsheets and entered data into computer to prepare documents for price estimates.

Authorization Coordinator

Anova Home Health
02.2017 - 01.2020
  • Entered authorization into the electronic medical records system and maintained consistent follow up on status of prior authorization request.
  • Worked closely with Customer Service Representatives and Clinicians to ensure required documentation is completed correctly and submitted to payers in a timely order to obtain authorization services.
  • Notified appropriate staff when patients have lost their health insurance coverage, when there was a change in coverage, or if authorizations have expired or cannot be obtained for needed services.
  • Verified patients medical insurance benefits.
  • Performed other related duties as assigned.

Authorization Coordinator

Personal Touch Home Care
08.2011 - 02.2017
  • Entered authorization into the electronic medical records system and maintained consistent follow up on status of prior authorization request.
  • Worked closely with Customer Service Representatives and Clinicians to ensure required documentation is completed correctly and submitted to payers in a timely order to obtain authorization services.

Administrative Assistant

Personal Touch Home Care
08.2010 - 08.2011
  • Scheduled office meetings and client appointments for staff.
  • Received and sorted incoming mail and packages to record, dispatch, or distribute to correct recipient. Drafted correspondence and other documents for CEO.
  • Managed filing systems, entered data and completed other clerical tasks.
  • Managed phone and email correspondence and handled incoming and outgoing mail and faxes.

Enrollment Specialist

United Health Group
09.2006 - 08.2010
  • Receiving, batching, and filing membership applications.
  • Verifying membership eligibility.
  • Running various reports for internal customers.
  • Reconciling memberships.
  • Interacting with many internal departments.

Education

Diploma - Medical Insurance Billing and Coding

Duff’s Business Institute
Pittsburgh, PA
09.2005

Skills

  • Eligibility Determinations
  • Provider Enrollment
  • Knowledge of ICD/CPT/CDM Codes
  • Medical terminology expertise
  • HIPAA Compliance
  • Data entry proficiency
  • Effective communication skills
  • Expertise in Microsoft Sharepoint
  • Insurance verification
  • Prior Authorization Processing
  • Medicare/Medicaid
  • Electronic Medical Record (EMR) Systems (Epic)

Timeline

Authorization Specialist

UPMC Magee
01.2020 - Current

Authorization Coordinator

Anova Home Health
02.2017 - 01.2020

Authorization Coordinator

Personal Touch Home Care
08.2011 - 02.2017

Administrative Assistant

Personal Touch Home Care
08.2010 - 08.2011

Enrollment Specialist

United Health Group
09.2006 - 08.2010

Diploma - Medical Insurance Billing and Coding

Duff’s Business Institute

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Ashley Whitley