AP

Open to opportunities

Ashley Pollard

@ashleypollard

Clinical Validation and payment integrity nurse leader driving CMS-compliant audits and patient-centered care.

What I'm looking for

I’m looking for a healthcare role where I can lead inpatient payment integrity/clinical validation, ensure CMS-compliant documentation, and mentor teams to improve outcomes while maintaining high-volume audit productivity.

I’m a results-oriented healthcare leader recognized for building strong rapport with patients, families, and interdisciplinary teams to drive collaboration and positive outcomes. I advocate for patient needs, navigate complex conversations with professionalism and empathy, and resolve conflicts while supporting accountability, growth, and continuous improvement. As a licensed vocational nurse, I focus on clear communication and compassionate, accessible education for patients and stakeholders.

Since July 2023, I’ve worked as a Clinical Validator at ClarisHealth, performing inpatient payment integrity audits through comprehensive medical record and itemized bill (UB-04) reviews. I validate charges against clinical documentation, coding guidelines, medical policies, and reimbursement rules—using advanced expertise in ICD-10-CM/PCS coding, DRG assignment, sequencing, and discharge disposition validation per CMS and Official Coding Guidelines. I also identify aberrant billing patterns for fraud, waste, or abuse, and support $500,000+ in validated recoverable savings per month in a high-volume production-driven audit environment.

Experience

Work history, roles, and key accomplishments

CL

Clinical Validator

ClarisHealth

Jul 2023 - Jan 2026 (2 years 6 months)

Performed inpatient payment integrity audits by reviewing medical records and UB-04 itemized bills to validate charges against clinical documentation, coding guidelines, and reimbursement rules. Supported $500,000+ in validated recoverable savings per month by identifying aberrant patterns and providing defensible clinical rationales while ensuring CMS compliance.

DRG Validation Payment Integrity Audits Discharge Disposition Validation

UO

Nurse Case Manager I

UnitedHealthcare / WellMed / Optum

Feb 2016 - Jul 2023 (7 years 5 months)

Coordinated patient follow-up through initial and weekly outreach to support continuity of care and reduce readmission risks by identifying knowledge deficits around care plans, medications, and follow-up appointments. Served as high-risk inpatient UM/liaison and conducted inpatient authorization reviews, plus retrospective clinical claim reviews and denials/appeals support while training new empl

Nurse Case Management Care Coordination Patient Education Inpatient UM Reviews Discharge Planning Interdisciplinary Collaboration Clinical Claims Review Denials Appeals

HE

Hiring & Training Manager

Humana (EHS)

Jan 2013 - Feb 2016 (3 years 1 month)

Led hiring and onboarding of nursing staff across Texas and Louisiana and developed training programs for nurses and office staff. Conducted member assessments and implemented care interventions in collaboration with interdisciplinary teams to improve outcomes and address barriers to care.

Training program development Interdisciplinary Collaboration Case Management Staff Development

Education

Degrees, certifications, and relevant coursework

HC

Hill College

Licensed Vocational Nurse (LVN) / LPN, Licensed Vocational Nursing

Completed a Licensed Vocational Nurse (LVN/LPN) program at Hill College, developing skills in patient rapport, compassionate communication, and accurate clinical documentation.

Tech stack

Software and tools used professionally

Gmail

Evidence

Cosmos

Enhance

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