Ashley Sims
Houston
Summary
Detail-oriented prior authorization specialist with extensive experience in managing medical documentation. Proven track record of collaborating with insurance companies to resolve denied claims and secure necessary prior approvals. Highly skilled in multitasking within fast-paced environments, ensuring efficiency and accuracy in all processes.
Overview
9
9
years of professional experience
Work History
Sr. Cash Auditor / Poster
Nutex Health
Houston
11.2024 - Current
- Reconcile and post daily cash receipts with accuracy and efficiency.
- Maintain detailed financial records and resolve posting discrepancies.
- Partner with billing departments to ensure timely payment processing.
- Analyze reporting trends to improve cash application procedures.
Accounts Receivable / Authorization Specialist
Sevita Health
Texas
06.2024 - 10.2024
- Processed prior authorization requests in compliance with payer policies.
- Resolved insurance denials and coordinated with providers to secure approvals.
- Maintained comprehensive documentation of authorizations and appeals.
- Utilized Waystar, Avatar, Filezilla, EOBs, and waiver reports for claim management.
Procedure Coordinator / Auditor
Innova Pain Center
Houston
10.2017 - 06.2024
- Managed prior authorizations for diagnostic imaging and specialty medications.
- Verified insurance eligibility and obtained approvals from specialty pharmacies (Accredo, ASP Care, BriovaRx/Optum, CVS Caremark).
- Handled high-volume requests while ensuring timely patient access to care.
- Provided training and guidance on payer documentation requirements.
Intake Coordinator
United Therapy Services
Houston
10.2016 - 10.2017
- Verified insurance coverage and pre-authorization needs for therapy services.
- Liaised with insurance representatives to secure timely authorizations.
- Maintained and updated EHRs with approval and appeal outcomes.
Education
Texas A&M University
01.2012
High School Diploma -
Mary Carroll High School
05.2009
Skills
- Financial analysis and reporting
- EClinicalWorks expertise
- Epic system knowledge
- Documentation review and auditing
- Customer service excellence
- Data analysis skills
- Medicaid management
- Prior authorization processes
- Patient access support
- Analytical thinking skills
- CPT coding proficiency
- Authorization management
- ICD-10 coding expertise
- Ethical standards
- HIPAA compliance
Timeline
Sr. Cash Auditor / Poster
Nutex Health
11.2024 - Current
Accounts Receivable / Authorization Specialist
Sevita Health
06.2024 - 10.2024
Procedure Coordinator / Auditor
Innova Pain Center
10.2017 - 06.2024
Intake Coordinator
United Therapy Services
10.2016 - 10.2017
Texas A&M University
High School Diploma -
Mary Carroll High School
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