Ashley Elkington Email and Phone Number

-Collaborate with Account Managers in resolving escalations tickets for group fully insured health plan members -Perform root cause analysis for escalated member issues, including claims outcomes, deductible issues, and other account questions -Summarize findings clearly and concisely so that Account Managers can effectively communicate information to members/group representatives -Recommend solutions as needed and initiate necessary actions (claim adjustment, pricing issues, technical difficulties) with relevant departments for streamlined resolution -Understand and effectively communicate a wide breadth of claims issues including deductibles, credit transfers, preventive care, benefits, specialty, etc-Serve as a liaison between Clinical, Legal, Engineering, Actuary, Coding, and Business teams to facilitate discussions, present solutions, and reach consensus on claims decisions -Review claims reconsideration requests and process claim adjustments in the claims platform-Audit High Dollar claims-Process complex medical claims by identifying, coding, and entering procedure codes, diagnosis codes, and provider information from invoices and receipts submitted by our members -Process hospital claims from UB04 claim forms and professional claims from HCFA 1500-Offer constructive feedback on processing instructions to proactively identify potential sources of errors and enhance accuracy-Run reports on quality assurance for claims processors-Run reports on large balance billing issues and identify solutions for members

-Supervised a team of Patient Care Coordinators.-Led weekly Team meetings.-Ran reports to include turnaround time for examinations and physician's reports.-Participated in marketing at annual conference.-Held monthly one-on-one check-ins with team members.

-Scheduled, coordinated, documented, and confirmed Independent Medical Evaluations, Impairment Ratings, and Peer Reviews appointments in CorVel's proprietary database.-Communicated directly with clients, regarding appointment scheduling, physician CVs/credentialing along with appointment changes, and fee schedule approvals.-Consistently communicated with our physician panel and clients in regards to file updates, Shows/No-Shows/Cancellations, etc.-Ensured client instructions and specifications were followed and requested questions were addressed in determinations and recommendations.-Reviewed upcoming scheduled IMEs and ensured the physicians had all materials needed for the exam(s) and provided additional documentation to the physicians as needed.-Assisted Medical Records Department with pulling medical records and appropriate documentation together for Peer Reviews.-Assisted with physician recruitment where needed in necessary regions and corresponded with necessary specialists.-Ensured content and format were the highest quality and in compliance with company and state standards.-Prepared and sent exam notification letters daily.-Coordinated ancillary services such as interpretation and transportation when needed.-Updated internal software with notes, documentation, and supported team and supervisor with special requests.

♦ Score retrieval agent's calls and audit notes to quality performance standards. ♦ Calibrate individual calls to audit quality standards with the Quality team, Team Leads, and Managers. ♦ Collect and provide statistical data to Team Leads and Managers evaluating team's performance, trends, and adherence to established procedures.♦ Mentor agents through periodic side-by-side training.♦ Provide constructive feedback through various measures including IMs, Way to Go emails, Quality Shoutout emails, WOW cards, and Trophy cards.♦ Answer agent's questions through IM, email, and walk throughs.♦ Assist Quality team members with answering questions and providing feedback.♦ Consistently meet and exceed performance metrics.♦ Attend and participate in team meetings and trainings to generate new ideas for quality process improvement and company operations.♦ Identify and relay to Team Leader areas for improvement within the evaluating and coaching delivery process.

♦ Actively coordinated medical and billing record retrieval for pilot projects. ♦ Experience in Healthcare, Life Insurance, Legal and Disability claims.♦ Proficiency in accurately sorting and processing of records received in a timely manner. ♦ Organized, distributed, and delegated workload per team member.♦ Created instructional guides for other agents to follow.♦ Composed active spreadsheets consisting of agent's workload on a daily and weekly basis.♦ Answer agent's questions and provide constructive feedback