Ashlee Harrell Email & Phone Number

Established Regulatory/Quality Department for Efficiency and Compliance:Implemented process improvements and corrective actions to meet regulatory standards, resulting in a 67% increase in production and a 37% reduction in documentation errors.Led cross-functional teams and initiatives, addressing barriers and enhancing staff satisfaction.Significant Improvement in Core Measures and Compliance:Improved Core Measure Results by 80% through staff education.Reduced patient and family complaints by 25%.Effective Auditing and Compliance Management:Conducted 300 internal audits, ensuring alignment with various regulatory guidelines.Analyzed historical data, enhancing Clinical Outcomes Participation rates from 10% to 75.4% and Psychiatric Core Measures from 34% to 65%.Lean Six Sigma Expertise and Process Optimization:Conducted root cause analyses and optimized processes using Six Sigma and Lean principles.Enhanced Employee Engagement and Continuous Improvement:Established an anonymous "Suggestion Box," resulting in a 33% increase in retention.Actively participated in the Service Excellence Committee to promote employee engagement and implemented industry best practices for continuous improvement.

Detroit, Michigan

Established Comprehensive Auditing Program:Developed and implemented an auditing program aligned with departmental and corporate objectives, in compliance with Medicare, Medicaid, and corporate regulations.Collaborated closely with leadership and UM trainers to ensure uniformity in Utilization Management (UM) processes and provided staff interventions to maintain contractual compliance.Enhanced Utilization Management Efficiency:Maintained consistent auditing metrics for a team of 50 staff members, identifying improvement opportunities.Designed and executed action plans resulting in a 47% increase in the efficiency of UM processes.Detailed Reporting and Data Analysis:Generated 10 detailed monthly reports analyzing utilization trends, outcomes, and related data.Effective Stakeholder Engagement:Engaged in meetings with internal staff and external stakeholders, including providers and payers, to discuss utilization management processes and policies.Streamlined Appeals Process:Coordinated the appeals process, bridging communication between providers, members, and payers when authorization was denied or modified due to noncompliance with criteria standards.Ensured Quality of Care and Cost-Efficiency:Facilitated utilization management for assigned health plans and providers, focusing on maintaining quality care and cost-effectiveness.Comprehensive Coding and Reimbursement Support:Provided guidance to providers on appropriate coding for services rendered and addressed reimbursement issues, resulting in a 63% improvement in submission accuracy.Diverse Skill Set and Collaboration:Collaborated with various teams, including vendor specialists, denials, provider education, interdepartmental staff, waiver disabilities, and data analysts.Utilized tools such as MCS, Tableau, Oracle, Excel, and SQL to enhance data analysis and reporting capabilities.

Fine-tuned policies and procedures for non-Institutional Care● I assembled a satisfaction survey for non-Institutional Care to evaluate if the quality of services measured to governmental standards. This helped meidentify deficits, which led to finding additional community partnerships to provide additional resources, and adequate support, so the needs of veteranswere met. Leading to a 20% increase in satisfaction for veteran support services. ● Completed Biopsychosocial for veterans who were diagnosed with SCI, MS, or ALC. Monitored client progress through review of records, reports, observation, interviews, and surveys. Participated in case conferences and team meetings to discuss progress of clients' treatment plans. While collaborating with multidisciplinary teams to coordinate care between agencies or providers.● Educated families on how best to support their loved ones living with mental illness, addiction issues, and/ or disabilities. ● Demonstrated cultural sensitivity when working with diverse populations from different ethnic backgrounds.● Ensured compliance with all state regulations governing the delivery of social work services.● Continuously researched community resources to provide referrals for appropriate services.● Actively participated in professional development activities such as continuing education seminars or workshops

Certification, Social Work Management

Master Of Social Work (M.S.W.), Social Work

Certification, Human Resources Management And Services

Bachelor Of Science (B.S.), Psychology

Certification In Gerontology, Social Work