Ashley Grant, Mba Email & Phone Number

San Juan, Puerto Rico

Monitoring overall department performance and managing the development, coordination, and administration of the Quality Oversight team, including setting, reviewing, and measuring quality standards and objectives.

Rancho Cordova, California

• Created policies and procedures reducing department errors by 75%. • Improved training procedures and materials. Thus, reducing training time by 400% • Developed Microsoft Access Data Base increasing department production from 300 to 10,000 claims reviewed per day.• Build Microsoft Excel tools• Reduced initially forecasted staffing needs by 78% while maintaining production.• Spearheaded interdepartmental and vendor meetings. Decreased issue mitigation turn-around times by 50%• Designed an automated process for department metrics data analysis. Freeing 2 hours daily for management. • Overhauled department culture. Therefore, attracting top talent from other departments. • Coordinated action plan with human resources to increase employee engagement to 100%.• Responsible for hiring, training, and scheduling• Implement Centers of Medicare & Medicaid Services (CMS) regulations• Communicated with management to complete compliance goals • Build Microsoft Excel tools• Created a process for monthly claims audits • Conduct meetings with Account Managers and Clinical Account Managers • Research, find solutions, and de-escalate possible issues• Manage and coordinate team meetings and one-on-one meetings• Manage and approve employee timesheets• Staff recruiting • Provide improvement recommendation to Medicaid Program team• Managed conflict resolutions between employees• Organized and distribute assignments to staff• Manage and train employees with urgent projects with deadlines• Manage and analyze metric standards to meet department standards• Quality audit task to ensure completed work meets intended compliance goals • Quality audit processed Medi-Cal reimbursement paper claims• Manage Medi-Cal/Medicaid Eligibility for members • Oversaw Medi-Cal and Molina Print document processes. • Train team members to use MS Access and MS Excel • Managed Medicare hospice and ESRD drug list to ensure accuracy with CMS

Rancho Cordova, California

Government Programs -Clinical Operations-Add new drugs to formularies according to plan criteria (New Drugs Weekly)-QA plan print documents for errors and take corrective action when needed-Analyze and audit pharmacy claims for Medicare and Medicaid-Researched possible issues and report to Medicare issue-reporting team-Coordinate re-training for other teammates-Keep track of metrics for claim/carrier counts for my team-QA all claims reviewed by the team to ensure accuracy-Research pharmacy and providers NPI for claims review-Delegated projects to teammates-Audit benefit entry to assure accuracy for claims adjudication-Successfully trained other Technicians with different learning skills-Train team members to use MS Access and MS Excel -Audit CMS Protected class drug claims-Manage yearly Medicare formulary standardized testing -Calculate member benefit accumulations -Provided excellent customer service with inbound and outbound calls-Handled Medicare Part D and Dual Medicare Medicaid plans-Communicated with Members, Doctors, and Pharmacies with inquiries on claims, co-pays, prior authorization, and eligibility-Effectively performed claim overrides/authorizations-Analyze California Child Service eligibility, other health insurance, and coordination of benefit-Managed Medicare hospice and ESRD drug list to ensure accuracy with CMS-Obtained clinical and verbal diagnosis to initiate coverage determination-Basic office duties such as managing voicemails, faxes, and mailings

Rancho Cordova, California, United States

-Providing outstanding communications skills and customer service experience for every client-Analyze incoming hard copy and electronic prescriptions to ensure they are legitimacy-Effectively transcribed and filled prescriptions for member-Analyze and research member’s Medi-Cal eligibility and applying out of pocket costs to member’s spend down in the state Medi-Cal’s website-Data analyst to ensure members don’t have duplicate drugs within the same strength or class-Accurately processed insurance billings, online and paper claims billing and reimbursement, and insurance verification-Prepared analytical report(s) to determine the most cost-effective Medicare plan for the following year for Medicare members-Act as a liaison between providers, members, and pharmacy to ensure claims adjudicate accurately within the plan's benefit-Obtained clinical diagnosis and other therapies member has tried and failed from provider to submit Treatment Authorization Request.-Help customers print and review their yearly financial report for tax purposes-Run a financial report to help cash-paying customers compare cash prices versus signing up for a Walgreen’s discount card-Analyze and solve issues pertaining to pharmacy claims chargeback and trying to recover possible loss claims-Time management on workflow for KPI (key performance indicator)-Handled incoming calls to check the status of prescriptions -Help members solve issues regarding their online claim rejection and copays inquiries-Maintained quality control and inventory of all medications in the Pharmacy

Master Of Business Administration - Mba, Responsible Business

Bachelor Of Science, Biology/Biological Sciences, General

Pharmaceutical Sciences

Licensed Pharmacy Technician - TCH 49810