Summary
Overview
Work History
Education
Skills
Special Projects Assignments
Certification
Timeline
Generic

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, GA
05.1996

Certified Medical Coding and Billing Professional -

Columbus Technical College
Columbus, GA
09.2015

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
Erika Horton