Ashley Nielson Email & Phone Number

Pollock Pines, Ca, Us

▪ Assisted with development and implementation of Inpatient Authorization process by working directly with consultants and management to identifying solutions and processes. ▪ Developed, implemented, and updated current guidelines and procedures as appropriate. ▪ Provided, Collected, and created reports for direct management and Directors to highlight discrepancies and provide solutions. ▪ Created training programs, resources and tools for colleagues and Team members. ▪ Mentored Teammates to help achieve team goals and to ensure the highest level of efficiency. ▪ Managed authorizations, denials, and special requests, from health insurance and case managers to impact Revenue Cycle ▪ Effectively overturned denials by Analyzing and interpreting payer communication and working directly with Internal and external clinical staff with insurance payers to obtain a resolution. ▪ Forwards Medical Records as needed to Insurance payers and handled all escalations. ▪ Multi- tasking by using several computer programs such as Midas, Epic, Right Fax, Etc... ▪ Meets and exceeds expectation such as daily, weekly, and monthly goals provided by Management.

Sacramento, California, United States

· Assigned and delegated work to specialists and representatives based on priority, volume, and workflow· Provided coaching, feedback, support, and training to all Team Members. · Onboarded new employees and assisted with Requesting access for systems and provided training. · Assisted with Technical issues when applicable. · Used independent judgement to solve any complications while overseeing a team of 20 employees. · Identified problems and implemented new processes for a better workflow and efficiency. · Oversaw performance and Quality for delegated tasks. · Scheduled all Team meetings to discuss, barriers, obstacles, and team engagement. · Attended all required management meetings which included collecting and providing data, creating reports, and any escalated issues. · Managed all escalations from directors and Case management departments.· Assisted Team members with assignments and tasks.

Sacramento, California Area

▪ Analyzed and interpreted medical guidelines to determine if appropriate information has been provided prior to sending reviews to external contracted payers.▪ Identified any missing information or needed necessary information on utilization reviews and escalates to Nurse or operational support representative for needed correction.▪ Forwarded completed and error free Utilization reviews to correct payer. ▪ Responded to Payer communication requests and followed departmental procedures to route requests appropriately.▪ Understood urgency and effectively worked with Care Coordination team to complete a high level of processed reviews in a timely manner.▪ Completed special requests to process urgent reviews in addition to completing daily worklist.

Rancho Cordova, Ca

▪ Scheduled veterans for medical appointments ▪ Regularly resolved escalations from the VA and network providers▪ Processed medical documents and screening paperwork for proper documentation▪ Called various providers to schedule appointments▪ Performed an average of 40 authorizations per day in different specialties of care▪ Provider liaison for specialty care ▪ Experience credentialing non-network providers for VA Choice program

Sacramento, Ca

▪ Provided customer service via phone by assisting patients with fulfilling medical equipment orders. On average 60-70 orders processed per day.▪ Obtained clinical information needed for processing orders. Including: HCPCS codes, ICD10 codes, oxygen saturation levels, and more.▪ Verified insurance information and eligibility by confirming insurance plan(s), deductible status, out of pocket expenses▪ Requested authorizations for medical equipment from insurance companies▪ Suggested process improvements implemented by management for order processing optimization▪ Coached trainees and colleagues on how to more effectively perform job duties▪ Scheduled training and equipment pick up appointments for patients

Rocklin, California

▪ Provided excellent customer service over the phone assisting members with daily financial needs. Average call volume: 80 calls per day. Average handle time: 4½ minutes.▪ Built and leveraged relationships with multiple departments to help better assist members▪ Assisted members with setting up online banking via multiple platforms, such as mobile and web.▪ Effectively offered multiple financial products to our membership base▪ Processed consumer loan payments

Sacramento, Ca

Received 50 to 70 calls per day and maintaining a low average handle time while providing a high level of customer satisfaction and retention, cross- selling business products and services. Overcoming customers banking concerns which may include: escalated issues missing deposits, cerdit or debit card issues, files claims ect..

Health Informaton Technology

Acitvely pursuing a degree in Health Information Technology.

Diploma, General Studies