Debbie Ashley Email and Phone Number

Responsible for Referenced Based Plan Program across all blocks of business.Patient Advocacy ProgramOON Claim negotiationsDialysis program creation and negotiationsTransplant program creation and negotiationsVendor relations

 Responsible for administration of Quality Assurance, Technical Research, Training, Claim Resolution and Recoveries for large TPA (in excess of 700 employees and over 200 clients including 3 State Healthcare Reform CO-OP’s) for active and Medicare populations. Demonstrated achievements in leadership, personnel management and development of corporate policies, job descriptions and corporate policies.  Medicare Part A and B claims Skilled Nursing Facilities/DRG Pricing Durable Medical Equipment Home Healthcare Medicare Claim reconsiderations Medicare Appeals Medicare compliance (laws, processing and adherence to timelines) Subrogation  Training & Development  Performance Management Organizational Development Manage claim inventory Manage Call Center Key individual regarding contract negotiations and renewals Senior Client Contact  Commercial active population benefit administration

Human Resource and Payroll OfficeDirect report to President/CEOServe in excess of 120 employees for all HR and Payroll related areas across 28 StatesResponsible for EEO, VETS 100, DOL, Affirmative Action plan implementation, compliance and reportingBenefit Coordinator responsible for selections, yearly negotiations with Carriers, Brokers and Agents. Responsible for Open Enrollment process, communication, implementation and literature. Medical,Dental,STD,LTD,Life,Vision,401K,COBRA,TRI-CARE SupplementalWorking knowledge of Affordable Care regulationsMaintain OSHA work related documentation including all reporting requirements Reconcile invoices for all benefit plans and programs Investigate any and all employee claims issues with Brokers, Carriers and Agencies as well as Unemployment claimsOversee FMLA for qualified candidatesMaintain all Federal and State regulations including FLSA and DOL requirementsProcess and upload 401K contributionsDeveloped Recruiting practices and Created On-boarding procedures utilizing a comprehensive HRIS application. Responsible for creating and implementing improvement action plans to meet individual deficiencies. When necessary: exit interviews and terminationsCreate evaluations, distribute, analyze and communicate feedback with personnelDevelop Improvement Action Plans for employees complete with benchmarks and expected results Create excel based reports for reporting, tracking and costingMaintain HRIS application corporately including positions, costing, performance, vacancies, attrition and various other Company specific areas of interest Work directly with employees for all related HR and Payroll issuesProcess payroll for 3 divisions within the Organization utilizing Quick Books and Paychex Active member SHRM for HR Professionals, PHR Certification Active member APA for Payroll Professionals, FCP Certified

Direct report to Senior Vice President. Manage 40 non-exempt employees, two Supervisors and one Manager. Manages inventory control, performance guarantees and staff Document control, call center and claim support. Administer claims support and call center for large Medicare Demonstration Group in the Coal Industry.Budget developing and control, wages, increases and expenditures. Hire and train employees. Staff career development including coaching and mentoring. Conduct salary reviews.