Director, Healthcare Consulting
Ashley Elmore came to Fulcrum Strategies with a wealth of experience in the managed care industry. Her position at Fulcrum is Director of Healthcare Consulting, handling a large and growing client base in the mid-Atlantic region. Ashley began her health care career at The Carolina Permanente Medical Group (Kaiser Permanente) in Raleigh, NC. There she had operational roles in credentialing research for TCPMG, compliance and provider relations. Remaining with Kaiser but moving into the health plan, Ashley moved into her new role as a Compliance Specialist, where she began processing capitation payments, completing capitated membership reconciliations and a host of other managed care contracting functions. She was also the primary contact with the North Carolina Department of Insurance, and resource for internal and external customers to interpret negotiated terms of contracts, capitation issues, and membership eligibility questions.
In 1999, she stepped away from Kaiser to function as a Managed Care Specialist for Carolina Premier Medical Group. This gave her a broad range of experience working in a provider setting, where she handled issues ranging from credentialing and contracting, to managing a staff that completed in-services. She was also responsible for developing and implementing a universal check-in, check-out, referral and billing process. From there, she moved on to United Health Care of North Carolina, based in Cary, NC. At United, she worked as a Network Development Specialist, responsible for physician retention in a nine-county territory. During her tenure at United, she was involved in physician recruitment, contracting and negotiation of cost-effective reimbursement rates, including primary care, specialty care, and hospital based physician groups.
Her last position before coming to Fulcrum Strategies was with Aetna US Healthcare. Ashley began as a Provider Relations Manager, responsible for overall management of Physician Recruiters, Provider Relations Representatives and administrative staff in Eastern North Carolina. She also completed special projects as requested by the Medical Director, General Manager, Sr. Sales Management and Network Manager, giving her close access to every major decision maker throughout the state’s health plan.
She was then promoted to Senior Network Account Manager. In this role, she was accountable for recruitment, contract negotiations, network retention, education, and resolving servicing issues for large physician groups, hospitals, hospital-based groups and physicians, ancillaries and facilities in Eastern North Carolina. She also reviewed contract reimbursement arrangements for compliance with standards, and determined the most appropriate system input methodology to facilitate accurate claim adjudication.