Ashley Nesbit Email & Phone Number

Telecommuter, Maryland Heights, Missouri

• Conduct comprehensive research and diligent investigation of information received from diverse sources pertaining to member grievances, demonstrating meticulous attention to detail and maintaining a high level of accuracy throughout the process.• Collaborate seamlessly with the Appeals & Grievance Department to address intricate issues, effectively coordinating and orchestrating comprehensive responses for the benefit of both members and providers.• Employ exceptional verbal and written communication skills to articulate findings and insights to internal departments, ensuring a coherent exchange of information that fosters informed decision-making.• Actively participate and contribute insights in meetings pertaining to policy decisions and process enhancement projects, playing a pivotal role in driving operational efficiency improvements.• Maintain unwavering adherence to the rigorous standards of state and federal compliance policies, reimbursement protocols, and contractual obligations, upholding the organization's commitment to ethical and legal practices.

Telecommuter, Maryland Heights, Missouri

• Undertake a pivotal role in the initial triage of members and meticulous management of administrative intake processes, deftly handling member admission and discharge information post-notification to ensure smooth transitions of care.• Forge effective collaborations with hospitals and clinical teams, ensuring a seamless flow of information that supports optimal patient care delivery.• Exhibit adeptness in managing incoming calls and skillfully addressing service requests from both providers and members, providing comprehensive insights into available network services and facilitating seamless member transfers to dedicated clinical personnel.• Spearhead the referrals process, deftly managing both incoming and outgoing referrals alongside prior authorizations, thus contributing significantly to the streamlining of healthcare operational workflows.• Assume multifaceted roles within the intake, notification, and census functions, playing an integral part in maintaining a well-organized and accurate records ecosystem that underpins effective decision-making.

• Render indispensable clinical support to healthcare providers and the quality of care nurse, demonstrating expertise in executing tasks such as the meticulous faxing of documents, judicious emailing of critical information, and the systematic ordering of essential medical charts.• Thrive in a dynamic virtual team environment, actively contributing to the cohesion of operations through seamless communication and effective task execution.• Leverage an array of intricate systems and judiciously analyze claims information to validate member details and provide accurate insights to pertinent stakeholders.• Play a pivotal role in generating both medical records requests and grievance response requests, thereby significantly bolstering the efficiency of community and state line of business operations.• Proactively initiate calls to healthcare providers to meticulously validate member data, effectively ensuring data accuracy and diligently following up on requested information.

Town & County, Missouri

• Orchestrated the meticulous enrollment of providers and practitioners into the provider data management system, ensuring the seamless integration of accurate and current information.• Skillfully updated provider and practitioner profiles, incorporating claims payment and directory details to maintain the precision of vital data.• Conducted diligent research and reviews within the provider data management system based on provider requests, enhancing system efficacy through meticulous updates.• Executed rigorous quality checks on systemic data, embracing claims processing and provider directory information, proactively identifying and rectifying discrepancies to uphold data integrity.

O’Fallon, Missouri

• Demonstrated expertise in evaluating loan statuses and conducting comprehensive research on properties and local ordinances, facilitating informed decisions on requisite actions.• Engaged in productive dialogues with code enforcement officers, city officials, attorneys, and vendor/contractors, fostering effective collaboration in resolving code violation matters.• Actively participated in code violation related hearings, liaising with local counsel and ensuring strict adherence to regulatory guidelines and compliance.

O'Fallon, Missouri, United States

• Leveraged advanced EA tools to meticulously assess property values, enabling the formulation and transmission of precise foreclosure bidding instructions to attorneys.• Provided insightful reporting on foreclosure sale outcomes and custody transfers through adept utilization of the Valeri system, enhancing transparency and accountability.• Managed a demanding high-volume pipeline with precision, orchestrating timely postponements of foreclosure sale dates and leveraging SCRA website insights for strategic decisions.

O'Fallon, Missouri, United States

• Deftly managed the integration of customer file requests, skillfully ordering and preparing documents for efficient scanning into FileNet and NLS systems.• Leveraged FileNet's capabilities to expedite research across multiple audits, consistently meeting a challenging 24-hour turnaround time.• Applied meticulous sorting techniques using the sorting wheel to optimize document organization and subsequent integration into the warehouse.

O'Fallon, Missouri, United States

• Pioneered collaborative efforts with Freddie Mac charge offs, meticulously validating supporting documentation for properties with compromised valuations or damage.• Demonstrated exceptional acumen in assessing risk exposure and providing well-informed recommendations to diverse investors and management tiers, showcasing comprehensive business insight.• Conducted rigorous equity analysis of defaulted loans, effectively advising on the most judicious and cost-effective routes for business progression and resolution.

Education record

Education record