Ashanti Page

Created, updated, maintained, and tested Standard Operating Procedures (SOPs) automation, and was accountable for configuring SOPHIA automation rules. Collaborated with developers to enhance SOPHIA logic for increased claims SOP automation. Prioritized and organized work to meet deadlines, serving as a technical resource for complex inquiries and promoting quality improvement through automation.

Worked directly with implementation teams and stakeholders to gather and interpret eligibility file structure requirements for new account installations. Audited and reviewed group structure data for consistency and accuracy, leading discussions to address inconsistencies and ensure remediation. Designed and maintained Facets group structure, setting up new products and running SQL queries for upd

Responsible for accurately accessing data reports, making edits to error messages, and uploading medical records to member files. Conducted WebEx meetings, worked with special edit tools, and collaborated with hospitals and clinical teams. Performed Aerial testing and debugging for potential errors for current processes, and sorted Excel spreadsheet data.

Collaborated with implementation teams and stakeholders to gather and interpret eligibility file structure requirements for new account installations. Audited and analyzed group structure data for consistency and accuracy, leading discussions to address inconsistencies. Designed and maintained Facets group structure, ensuring reliability and alignment with other applications, and performed end-to-

Provided excellent customer service, practiced HIPAA compliance, and scheduled appointments within Dentrix. Processed incoming payments, handled insurance verification and eligibility checks, and quoted dental benefits. Updated members' plans and maintained authorizations and pharmacy files, looking up medication terms and posting doctor's notes.

Provided excellent customer service while maintaining HIPAA compliance, scheduling appointments within Dentrix and monitoring schedules. Processed incoming payments, handled insurance verification and eligibility checks, and quoted dental benefits. Updated members' plans and maintained authorizations for pharmacy files.

Maintained a caseload of non-clinical appeals and complaints, processing them according to policies and workflows. Documented processes and findings within the database, contacting members and providers within required timeframes. Identified risk areas, reported to unit manager, and prepared written materials for notification and tracking.

Actively listened and probed callers to determine call purpose, communicating information regarding member eligibility, benefits, and claim status. Referred patients to Magellan's Care Management team and providers to Provider Services. Assisted providers with claims issues, website registration, and educated them on health plan initiatives.

Actively listened and probed callers to determine the purpose of calls, researching and communicating information regarding member eligibility, benefits, and claim status. Referred patients to Magellan's Care Management team and provided information on in-network/out-of-network reimbursement rates. Assisted providers with claims issues and website inquiries.

Processed authorizations for commercial and primary Medicare, handling numerous inbound and outbound calls with providers. Worked fax authorizations through RightFax and used Facets 4.0 and 5.1, Max-MC, and Java to store authorizations. Assisted with special projects for Facets 5.1 implementation, creating checklists to ensure segment matching.

Processed authorizations for commercial and primary Medicare, handling numerous inbound and outbound calls with providers. Worked fax authorizations through RightFax and utilized Facets (4.0 and 5.1), Max-mc, and Java to store authorizations. Assisted with special projects, including creating checklists for Facets 5.1 implementation.

Handled all electronic healthcare claims, processed corrected claims, and addressed edits and corrections. Documented findings of denials for submission and investigated denials. Used Microsoft Office Communicator for communication and prepared corrected claims for processing using Facets 4.0 and 5.1.

Handled all electronic healthcare claims, processed corrected claims, and addressed edits and made corrections. Documented findings of denials for submission of corrected claims and investigated denials. Utilized Microsoft Office Communicator for communication and prepared corrected claims for processing using Facets 4.0 and 5.1.

Handled electronic claims, sorting files, and performing data entry, resolving errors related to formatting, content, or timeliness. Supported HIPAA 4010 and ICD9 environments, communicating with trading partners on electronic transaction issues. Managed EDI projects, formatted Medicare crossovers, and processed Medicare claims for special processing.

Handled electronic claims, sorting files, performing data entry, and using Word and Excel for information. Resolved errors, identified formatting, data content, or timeliness issues, and communicated with trading partners. Supported HIPAA 4010 and ICD9 environments, coordinating setup and approval of providers for the web portal.

Implemented and enforced policies and procedures, ensuring compliance with regulations and tenancy agreements. Oversaw staff performing rent calculations, income verification, and move-in/move-out procedures. Provided guidance on complex tenancy issues, resolved tenant disputes, and conducted drug screenings and data entry.

Implemented and enforced VNHS policies and procedures, ensuring compliance with the Residential Tenancy Act and regulations. Oversaw staff performing rent calculations, income verification, and move-in/move-out procedures. Provided guidance on complex tenancy issues, authorized notices to end tenancy, and conducted drug screenings.

Collected personal information for loan applications, assessing borrower credit and financial history using underwriting software. Explained the loan process to applicants and dealt with multiple banks to secure optimal loan amounts and interest rates. Assigned customers to loan processors and handled inquiries for refinancing and equity loans.

Answered inbound calls regarding primary care physician changes and assisted Medicaid recipients with program updates. Investigated complaints against providers and practices, tracking them using a data interchange program. Made outbound calls to provider offices for availability and followed up on filed complaints.

Collected personal information for loan applications, assessing borrower credit and financial history. Explained the loan process to applicants and used underwriting software to determine loan affordability. Dealt with multiple banks to secure optimal loan amounts and interest rates for clients, assigning customers to loan processors.

Answered inbound calls regarding primary care physician changes and assisted Medicaid recipients with program updates. Investigated complaints against providers and practices, tracking them using a data interchange program. Made outbound calls to provider offices for availability and followed up on filed complaints.

Implemented programs designed to ensure proper application of contracted rates and reimbursement policies for company affiliates. Performed analysis of claims, pre and post-payment, to ensure proper pricing of contracts, reimbursement policies, and procedures. Reviewed claim disputes to verify correct pricing and analyzed claim inquiry data to determine root cause of errors.

Implemented programs designed to ensure proper application of contracted rates and reimbursement policies for company affiliates. Performed analysis of claims, pre and post-payment, to ensure proper pricing of contracts and reimbursement policies. Investigated non-standard requests and problems, providing analytical expertise and accurate pricing direction while meeting aggressive production goals

Established consistent processes and documentation with the Health Homes Medicaid program, initiating outreach to eligible Medicaid recipients. Created Excel spreadsheets for data reporting for Health Homes Community Coordinators. Assisted with updating member profiles and charts within Community Care clinical software, checking eligibility daily.

Established consistent processes and documentation for the Health Homes Medicaid program, initiating outreach to eligible recipients and documenting attempts in clinical software. Created Excel spreadsheets for data reporting and assisted with updating member profiles and charts within Community Care. Checked member eligibility daily and updated data reporting pivot tables.

Responsible for accurately accessing data reports, making edits to error messages, and uploading medical records to member files. Assigned cases to RNs for review and ran daily data reports, communicating through Microsoft Outlook and conducting WebEx meetings. Performed Aerial testing and debugging for potential errors, ensuring functionality of updates.

Responsible for initial triage of members, managing admissions/discharge information, and working with hospitals and clinical teams. Managed referral processes and incoming grievances/medical records, assigning cases to clinicians for review. Reviewed, investigated, and tracked Medicare, Medicaid, and Commercial grievances, appeals, and provider claims disputes using EMR/EPIC and Icare systems.

Responsible for initial triage of members, managing admissions/discharge information, and working with hospitals and clinical teams. Managed the referral process and incoming grievances/medical records, creating tasks for follow-up. Reviewed, investigated, and tracked Medicare, Medicaid, and Commercial grievances, appeals, and provider claims disputes.

Input patient visits into a data billing system, processed mileage/payroll activity logs, and validated visits with clinical notes. Input patient data into Oasis system and client data for plan of care/medical updates. Reviewed and updated RFPs, handled precertification and authorizations, and analyzed claims and billing submissions using EDI and UNET platforms.

Input patient visits into a data billing system and processed mileage/payroll activity logs, validating visits with clinical notes. Maintained tracking systems and notified directors of delinquent documentation. Analyzed claims and billing submissions, communicating with clinicians and staff using electronic data interchange (EDI).

Scheduled all OB/GYN appointments, checked patient eligibility, and tracked appointments daily in the Greenway database. Coordinated physician's surgery schedules, working closely with patients, physicians, and hospital staff. Maintained an Excel spreadsheet for scheduling and reporting.

Scheduled all OB/GYN appointments, checked patient eligibility, and tracked appointments, logging them daily into the Greenway database. Coordinated physician's surgery schedules, working closely with patients, physicians, and hospital staff. Utilized Excel spreadsheets for various tasks.

Maintained a caseload of non-clinical appeals and complaints, processing them according to policies and workflows. Documented processes and findings, contacting members and providers within required timeframes. Reviewed and updated RFPs, audited proposals, and prepared information on appeals for external review organizations.

Performed collection calls and correspondence, providing customer service for collection issues and processing refunds. Reviewed account adjustments, resolved client discrepancies, and monitored assigned accounts to reduce delinquency. Utilized EDI submissions and UB92 claim submissions for billing processes.

Handled collection calls and correspondence in a fast-paced, goal-oriented department, providing customer service for collection issues and processing refunds. Reviewed account adjustments, resolved client discrepancies, and monitored assigned accounts. Utilized EDI and UB92 claim submissions, analyzing data for optimal healthcare management.

Worked claims edits and fixed claims that dropped off adjudication runs, managing pend reports in Word and Excel. Created pivot tables for financial reporting and reconciled client account transactions in the database. Collaborated with clinical coding consultants to apply coding guidelines and reconciled UB92 and physician claims submissions.

Worked claims edits and fixed claims that dropped off adjudication runs, managing pend reports in Word and Excel. Created pivot tables for financial reporting and reconciled client account transactions in the database. Utilized EDI to read computer language and characters, collaborating with clinical coding consultants.

Reviewed, investigated, and tracked Medicare, Medicaid, and Commercial grievances, appeals, and provider claims disputes. Pursued formal resolution for members and providers within guidelines, screening all incoming grievances. Gathered, analyzed, and reported provider complaints, conducting chart and contract audits.

Reviewed, investigated, and tracked all Medicare, Medicaid, and Commercial grievances, appeals, and provider claims disputes. Pursued formal resolution for members and providers within guidelines, screening incoming grievances. Gathered, analyzed, and reported provider complaints, conducting chart and contract audits.

Currently pursuing a Bachelor's Degree in Computer Information Systems with a specialization in Health Informatics. This program focuses on the intersection of healthcare and information technology.

Currently pursuing a Bachelor's Degree in Computer Information Systems with a specialization in Health Informatics. This program focuses on the intersection of computer science and healthcare.

Obtained a High School Diploma in 1999, focusing on General Studies. This foundational education prepared for further academic and professional pursuits.

Graduated in August 2010 with an Associate Degree in Healthcare Administration. The curriculum provided a foundational understanding of healthcare management and administrative processes.