Ashly Watson

Detail-oriented healthcare professional with 10+ years of experience in provider credentialing, medical claims processing, revenue cycle management, reimbursement, and insurance billing. Experienced in provider credentialing and recredentialing, primary source verification, claims auditing, appeals, payment processing, and regulatory compliance. Strong background working with healthcare providers, insurance carriers, and cross-functional teams to resolve complex claims and billing issues while maintaining accuracy and compliance with industry standards.

Credentialing Specialist at Partnership HealthPlan of California — TEKsystems (2025-04 – Present)

• Coordinate provider credentialing and recredentialing activities for Medi-Cal providers.
• Perform primary source verification using federal, state, licensing board, and other approved resources.
• Maintain accurate provider records in accordance with NCQA and DHCS standards.
• Conduct sanction screenings and verify provider information through NPPES and CCS databases.
• Review credentialing documentation to ensure completeness, accuracy, and timely processing.
• Support compliance by maintaining accurate and up-to-date provider credentialing information.

Revenue Cycle Specialist at Eating Recovery Center (2022-06 – 2025-02)

• Process patient charges and insurance payments accurately and efficiently.
• Follow up on outstanding insurance claims to support timely reimbursement.
• Perform daily balancing and close day sheets to maintain accurate financial records.
• Communicate with insurance carriers to research and resolve billing and payment discrepancies.
• Review account information and payment activity to identify and resolve issues affecting reimbursement.

Medical Claims Auditor at Foundation for Medical Care (2021-02 – 2021-10)

• Audit HMO and medical claims for coding accuracy, payment accuracy, and compliance.
• Review medical records and supporting documentation for adherence to federal regulations and industry standards.
• Research unlisted CPT codes to determine appropriate pricing methodologies.
• Perform daily verification audits to identify potential errors and maintain claims accuracy.
• Review claims documentation and coding information to support accurate payment decisions.

Billing Specialist at Aerotek (2020-06 – 2021-02)

• Process commercial and HMO insurance claims in accordance with payer requirements.
• Collaborate with coding and payment posting teams to investigate and resolve claims issues.
• Submit and monitor claims appeals when additional review or reimbursement action is required.
• Review patient and insurance balances to identify billing discrepancies and maintain account accuracy.
• Assist patients with payment arrangements and account resolution options.

Reimbursement Specialist at Kaweah Delta Hospital (2019-12 – 2020-04)

• Process Medicare, Medicaid, commercial, and HMO insurance claims.
• Identify reimbursement variances and underpayments requiring further investigation.
• Submit appeals to support accurate reimbursement in accordance with contractual agreements.
• Maintain compliance with payer-specific billing and reimbursement requirements.
• Review claim payment information to identify discrepancies and support appropriate resolution.

Lead Commercial Claims Analyst at Foundation for Medical Care (2017-03 – 2019-03)

• Process HMO claims for patients assigned to Key Medical Group.
• Assist providers and patients with claims-related questions and issue resolution.
• Serve as a resource for team members regarding commercial claims processing procedures.
• Review claims using SYMKEY to verify accuracy prior to payment authorization.
• Support team members with claims research and resolution of complex processing issues.

Claims Processor at Cigna (2015-07 – 2017-03)

• Process international medical and dental claims accurately and efficiently.
• Review claim documentation to ensure compliance with payer guidelines and claim requirements.
• Maintain productivity and quality standards while managing high-volume claim workloads.
• Review supporting documentation to determine appropriate claim processing and payment.

Administrative Medical Assistant at Milan Institute (2011-04)

Administrative Medical Assistant – Milan Institute (2011-04)