Ashley Jimenez

210-***-****

ad3l4h@r.postjobfree.com

SUMMARY

Ability to maintain confidentiality, follow guidelines, and apply proper policies and procedures. Excellent ability to adapt to difficult situations, detail oriented, and capable problem solver. Outstanding organizational skills with the ability to multi-task in a fast-pace environment. PROFESSIONAL EXPERIENCE

United Health Group Sept 2022- Nov 2023

Medicare & Retirement claims operations

• Provide expertise or general claims support by reviewing, researching, investigating, processing and adjusting claims.

• Analyze and identify trends and provide reports as necessary.

• Constantly meet established productivity and quality standards.

• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.

• Reviewing ICD-10 codes on claim to ensure proper billing of diagnoses codes. Medical Support Assistant (OA) MAY 2021- JAN 2022

GS-0679-05

Consult Appointment Management office (CAMO)

OPM Office Automation

• Receives telephone calls from the vast local active and retired military community and their family members on a multi-line mechanized automatic call distribution system. Receives calls from out-of-town patients and out of town Army, Air Force, and Navy medical facilities on four long distance line. Uses knowledge of medical terminology, clinic standard operating procedures (SOPs) and various appointment templates to analyze medical referrals over the phone and in person and appointment request to determine which of the over 61 specialty or subspecialty clinics of the BAMC regional health care facility.

• Utilizes a personal computer to access the Composite Health Care System

(CHCS) and the Ambulatory Data System (ADS) used an assigned restricted code that provides access to the necessary screens of the appointment system.

• Provides information in response to patient inquires on medical providers scheduled release date, authorized treatment, extent of medical, laboratory, X-ray and pharmacy coverage and general hospital procedures and regulations.

• Provides appointment and scheduling procedure information to clinic and other staff personnel. Monitors and maintains waiting list for patients requiring medical treatment. Provides appointments for referrals/consultations generated from

• internal and external organizations. Calls patients to change, cancel and/or remind patient of upcoming appointment and makes appropriate database requirements/ changes. Generates end of day reports as necessary pertaining to appointing outcomes and schedules management.

• Obtains, tracks and inputs appointments templates, ensuring access standards are met. Scans, reviews, makes appointments, and routes consults using the electronic consult system of CHCS. Produces management reports using business objects as needed. Performs other duties as assigned.

Data Technician AUG 2019 – May 2021

T&T Consulting Services (AFMRA)

• Identifies, analyses, recommends, develops, and implements enterprise technical solutions that reduce and/or eliminate current patient registration errors, duplicates, and configuration control processes.

• Reviews, resolves, and corrects patient files for accuracy and completeness within AHLTA/ CHCS/DEERS and merges duplicate records.

• Ensures all patient file related information in CHCS is consistent with DoD, DHA, DEERS, and AF directives.

• Resolves National Enrollment Database (NED) Patient/Primary Care Information Transfer

(PIT) discrepancies.

• Develops quantifiable impact of work accomplished, to include productivity targets and Return on Investment (ROI) reports.

• Monitors, documents and communicates changes in patient identity or sponsorship which impacts medical records tracking.

• Provides services in the standardization and improvement of Medical Record Tracking, medical record accountability, and medical record retirement processes.

• Contributes to T&T proposal activities and all other duties as assigned by management. Medical Booking Clerk JUN 2018 – AUG 2019

Consult Appointment Management Office (CAMO)

• Schedules medical appointments and determines eligibility for services; communicate by phone, secure messaging, and/or other methods used by appointment requestor.

• Performs multiple duties: Schedules patient and specialty care appointments and specialty care consults visits.

• Validates beneficiary eligibility for appropriate booking using DEERS.

• Authenticates patient’s demographic information prior to booking appointments.

• Utilizes AHLTA, CHCS, and MHS to schedule appointments.

• Registers patients not in system, (i.e. newborns) and updated existing patient demographics.

• Calls patients, send mailers (appointments by mail), or responds to secure messaging requests as needed to schedule, reschedule, and/or cancel appointments.

• Routes initial specialty referral consults to specialty care clinics in accordance with capability reports and standard operating procedure.

ACHIEVEMENTS

Awarded outstanding performer, Feb 2018

Awarded for perfect attendance.

EDUCATION

Marquee Learning Center High School Diploma

Proficient in Microsoft Office, CHCS, AHLTA, DEERS, Military Health Systems (MHS)

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