Erika Horton
Waverly Hall,GA
Summary
Professional claims specialist with strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Effective team collaborator with focus on achieving results and adapting to evolving requirements. Skilled in negotiation, customer service, and regulatory compliance, consistently ensuring accuracy and fairness.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Claims Specialist I, II and III
Aflac
06.2017 - Current
- Gather documentation, research state-specific manuals and ensure claims are managed according to all state, federal, compliance and regulatory requirements
- Works closely with management to analyze reporting and ensure deadlines were met
- Works cross functionally with other business units to ensure proper documents are forwarded to the appropriate destination
- Responsible for researching and auditing claims for missed benefits for the quality and audit leadership team
- Utilizes excellent communication and relationship skills to ensure quality service for internal and external customers
- Assigned to work immediate action and escalated files from leadership
- Processed claims for several lines of business to include accident, disability, and multi-line processing which spans hospital, intensive care, specified events and others
Physician Practice Specialist
St. Francis Hospital
12.2009 - 06.2017
- Manage and organization of patient medical records
- Verification of insurance for office visits and outpatient procedures
- Review medical charts to assist in precertification
- Precertification-Authorization from major medical insurance providers for outpatient services
- Assist with medical coding processes to include office visits and outpatient procedures
- Answer physician calls to schedule necessary appointments
- Prepare medical documentation to send to billing department
Education
High School Diploma -
McIntosh High School
Peachtree City, GA05.1996
Certified Medical Coding and Billing Professional -
Columbus Technical College
Columbus, GA09.2015
Skills
- Claims
- Claims processing
- Claims investigation
- Verbal communication
- Microsoft office
- Claims analysis
- Policy interpretation
- Complex claims consulting
- Time management
- Decision-making
- Attention to detail
- Problem-solving
- Teamwork and collaboration
- Organizing and prioritizing work
Special Projects Assignments
- Certification in Medical Coding & Billing
- Certification in Customer Service
- Assisted the Claims Verification Team in production during crucial overtime to reduce volume
- Assisted with initiative to decrease volumes with processing Dental Claims
- Trained other Dental specialists to work on special projects in Dental Processing: New York, HO plans, Virginia, Eastern Claims
- Summary Sheet Validation Project
- Main report for the Orphan Report Project
- Subject matter expert in processing Accident, Disability, and Multi-line processing using Pega and CPS
Certification
- Certified Medical Coding and Billing Professional -Columbus Technical College - 2015
Timeline
Claims Specialist I, II and III
Aflac
06.2017 - Current
Physician Practice Specialist
St. Francis Hospital
12.2009 - 06.2017
- Certified Medical Coding and Billing Professional -Columbus Technical College - 2015
High School Diploma -
McIntosh High School
Certified Medical Coding and Billing Professional -
Columbus Technical College
Similar Profiles
Joshua BarzJoshua Barz
Insurance Agent at AFLACInsurance Agent at AFLAC
Matthew O'HanlonMatthew O'Hanlon
Regional Sales Coordinator at AFLACRegional Sales Coordinator at AFLAC
Latesha ReedLatesha Reed
Customer Care Advocate at AflacCustomer Care Advocate at Aflac