Ashley Graham White
Elgin
Summary
To leverage extensive experience in medical coding and reimbursement to excel by contributing to efficient claim processing and resolution.
Professional in medical coding and reimbursement with strong focus on accuracy and compliance. Skilled in coding systems, documentation review, and revenue cycle management. Known for team collaboration and adaptability, ensuring seamless workflow and achieving results. Dependable and responsive to changing needs, with commitment to maintaining high standards and driving efficiency.
Overview
15
15
years of professional experience
Work History
Coding Reimbursement Specialist II - Denials Coding Team
Atrium Health Centralized Coding Department
12.2019 - Current
- Implemented correct coding practices by appending accurate modifiers for failed or denied claims, enhancing the efficiency of claim resolutions
- Researched payer guidelines and resolutions to coding denials for various specialties
- Utilized HCPCS and diagnosis codes effectively to address medical necessity denials across multiple specialties including Pediatric, Family Medicine, Geriatrics, Sports Medicine, Gastroenterology, and Ophthalmology
- Conducted thorough reviews of Medicare Guidelines alongside LCD/NCD for specific procedure codes to ensure accurate coding
Coding Denial Account Representative / ProFee Coding Department
Palmetto Health/USC Medical Group
06.2019 - 12.2019
- Applied precise coding techniques with appropriate modifiers on denied claims improving denial management processes
- Managed denials from Medicare Advantage payers through detailed analysis of Medicare Guidelines and LCD/NCD requirements
- Successfully appealed incorrect denials by presenting comprehensive medical records supporting medical necessity
Payment Verification Specialist - Payment Integrity Department
Palmetto Health-Corporate
07.2014 - 06.2019
- Verified accuracy of insurance payments against Explanation of Benefits leading to timely adjustments/refunds when necessary
- Facilitated team meetings monthly focusing on resolving hospital claim adjustment issues efficiently
- Addressed short pay concerns proactively ensuring adherence to contract terms with network payers
Patient Financial Services-Follow up Rep
Palmetto Health-Corporate
12.2009 - 07.2014
- Verify if insurance payments are accurate and timely and retrieve EOB regarding denials
- Complete necessary adjustments and refunds to patients and insurance companies when needed.
- Conduct team meetings and take monthly minutes.
- Resolve issues and concerns regarding hospital claims adjustments timely and efficiently,
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Enhanced company reputation by providing exceptional customer service and support.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Collaborated with team members to achieve monthly goals.
Education
CPC and CRC Certification -
Skills
- Medical Necessity Analysis
- Claim Resolution
- Modifier Application
- HCPCS & Diagnosis Codes
- Payer Guideline Compliance
- Encoder Plus Expertise
- Cerner System Proficiency
- Clinical documentation review
Pronouns
She/Her
Profiles
CPC, CRC
Timeline
Coding Reimbursement Specialist II - Denials Coding Team
Atrium Health Centralized Coding Department
12.2019 - Current
Coding Denial Account Representative / ProFee Coding Department
Palmetto Health/USC Medical Group
06.2019 - 12.2019
Payment Verification Specialist - Payment Integrity Department
Palmetto Health-Corporate
07.2014 - 06.2019
Patient Financial Services-Follow up Rep
Palmetto Health-Corporate
12.2009 - 07.2014
CPC and CRC Certification -
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