Ashley N. Marsh
Providence Health Plan
Corvallis
17
years of professional experience
Detail-oriented healthcare professional with 15 years in utilization review, prior authorization, and patient care coordination. Evaluated authorization requests and ensured compliance with clinical guidelines while maintaining high productivity standards. Served as a subject matter expert, training new caregivers and leading resource improvement initiatives to enhance operations and member advocacy.
Work History
Senior Utilization Review Specialist (Remote)
2 Years 3 Months- Perform comprehensive utilization reviews to determine medical necessity and appropriate levels of care using established clinical guidelines and health plan criteria.
- Review complex authorization requests while ensuring compliance with regulatory requirements, benefit plans, and organizational policies.
- Serve as a subject matter expert for utilization review processes and provide guidance to team members on complex cases.
- Collaborate with providers, case managers, and internal departments to support timely and accurate authorization decisions.
- Identify opportunities for process improvement and contribute to departmental initiatives that enhance quality and efficiency.
- Consistently achieve productivity, quality, and turnaround time standards in a high-volume environment.
- Assist leadership with operational support and workflow coordination.
- Train and mentor new caregivers, providing education on processes, systems, and best practices.
- Develop and manage the department's weekly staffing schedule to support operational needs and workload distribution.
- Participate in the OneNote Committee, maintaining and updating departmental resources to improve team efficiency, consistency, and access to information.
Utilization Review Specialist
5 Years- Reviewed inpatient, outpatient, and specialty authorization requests for medical necessity and benefit eligibility.
- Applied evidence-based clinical criteria and plan benefits to ensure accurate coverage determinations.
- Maintained high productivity and quality standards while managing a large volume of authorization requests.
- Communicated with providers and clinical staff to obtain necessary documentation and resolve authorization issues.
- Ensured compliance with Medicare, commercial, and organizational requirements.
- Assisted with onboarding and training efforts for new team members.
- Supported workflow improvements and departmental quality initiatives.
Prior Authorization Technician
2 Years- Processed prior authorization requests accurately and efficiently while meeting regulatory turnaround time requirements.
- Verified benefits, eligibility, and authorization requirements for a variety of medical services and procedures.
- Reviewed clinical documentation for completeness and obtained additional information from providers when necessary.
- Coordinated communication between members, providers, and internal departments to facilitate timely authorization decisions.
- Maintained accurate documentation and case records within multiple healthcare systems.
- Assisted in resolving authorization and claims-related issues while ensuring exceptional customer service.
Patient Care Coordinator / Billing Specialist
6 Years 10 Months- Coordinated patient scheduling, registration, and daily clinic operations.
- Verified insurance coverage, benefits, and eligibility prior to appointments and procedures.
- Educated patients regarding insurance requirements, billing processes, and financial responsibilities.
- Processed medical claims and managed billing functions, including payment posting, account reconciliation, and insurance follow-up.
- Resolved billing discrepancies and claim issues with insurance carriers and patients.
- Maintained accurate patient records and ensured compliance with HIPAA and documentation requirements.
- Collaborated with providers and clinical staff to support efficient patient flow and high-quality patient care.
- Delivered exceptional customer service while managing multiple priorities in a fast-paced healthcare environment.
Patient Care Coordinator
9 Months- Scheduled patient appointments and coordinated provider calendars to optimize clinic efficiency.
- Managed patient registration and maintained accurate demographic and insurance information.
- Processed and maintained medical records in accordance with organizational and regulatory requirements.
- Responded to patient inquiries and coordinated communication between patients and providers.
- Assisted with referrals, appointment reminders, and follow-up scheduling.
- Supported front-office operations while ensuring a positive patient experience.
- Maintained confidentiality and compliance with HIPAA guidelines.
Education
- Medical Insurance Billing And Coding
Skills
Utilization Review
Medical Necessity Determinations
Prior Authorization Management
Medicare & Commercial Plan Guidelines
Regulatory Compliance
Quality Assurance
Workflow Coordination
Process Improvement
Team Training & Mentorship
Medical Records Management
Patient Scheduling & Registration
Medical Billing & Coding Support
Provider Communication
Schedule Coordination
Customer service
Special Projects & Leadership Contributions
- Coordinate and develop the weekly department staffing schedule.
- Member of the OneNote Committee responsible for maintaining and updating departmental resources and reference materials.
- Train and mentor new caregivers, supporting onboarding, knowledge development, and successful integration into team workflows.
- Serve as a resource for process clarification, policy interpretation, and workflow support.
- Contribute to process improvement initiatives focused on quality, consistency, and operational efficiency.
Key Strengths
- Proven progression through three increasingly responsible roles within Providence Health Plan.
- Strong expertise in prior authorization, utilization review, and healthcare compliance.
- Trusted subject matter expert and team resource.
- Excellent attention to detail with a commitment to quality and accuracy.
- Collaborative leader who supports team success through training, communication, and process improvement.
- Consistently adaptable in high-volume, fast-paced healthcare environments.
Timeline
Senior Utilization Review Specialist (Remote)
Providence Health Plan
05.2024 - CurrentRead More
Utilization Review Specialist
Providence Health Plan
05.2019 - 05.2024Read More
Prior Authorization Technician
Providence Health Plan
05.2017 - 05.2019Read More
Patient Care Coordinator / Billing Specialist
McMinnville Eye Clinic
07.2010 - 05.2017Read More
Patient Care Coordinator
Villa Medical Clinic
09.2009 - 06.2010Read More
Everest Institute
from Medical Insurance Billing And Coding
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