Christal Horner
Hillsborough,NC
Summary
PROFILE OVERVIEW
- Leadership and Administration
- Cross-functional Team Management
- Communication and Coordination
- Problem-solving, Analysis Researching, and Reporting
- Performance Improvement
Insurance professional with extensive claims processing through benefits, authorizations, appeals, billing, and account management. Detail-oriented professional offering 20+ years of experience in related roles. Exceptional abilities in conducting research, problem-solving, and prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills, and superior work ethic for top job performance. Noted as an exceptionally well-organized individual demonstrating self-motivation, creativity, initiative, and inspiration toward team members to achieve their potential while working toward common goals. Excellent customer relations skills combined with an analytical approach to handling revenue payment delays.
Overview
28
28
years of professional experience
Work History
Billing Specialist
National Counseling Group
Raleigh, NC
12.2021 - Current
- Monitor, research, and resolve unpaid, rejected and denied claims for Behavioral Health.
- Initiate and follow up on appeals of denied claims for Commercial and Medicaid carriers.
- Track and monitor billing and payments to effectively manage accounts receivable.
- Update client accounts with correct insurance and authorization details.
- Communicate with payers to resolve reimbursement issues to ensure clean claims.
- Submit claims through billing clearinghouse for electronic processing.
- Audit client services for any errors and payer trends.
- Work collaboratively with team members and other internal departments.
- Generate and submit client statements.
- Generate insurance pre-billing reports and weekly aging reports.
- Extensive knowledge of Virginia Billing rules with Medicaid, MCOs, Medicare, and all Third-Party Payers.
- Reviewed and reconciled customer accounts to manage the accuracy of payments
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification
MED-EL CORPORATION
10.2013 - 12.2021
Senior Reimbursement Lead
07.2021 - 12.2021
- Mentored and Supervised front-end Reimbursement team of 17 members.
- Trained new staff on department processes and procedures.
- Modified, updated, and processed existing policies.
- Maintained same duties as Reimbursement Lead.
- Progressed in roles from Representative to Senior Reimbursement Lead in over 4 years.
Reimbursement Lead
03.2019 - 06.2021
- Oversaw Reimbursement department processing activities including claims processing, billing, collections, authorizations, and appeals.
- Managed work queues to ensure timely processing of orders.
- Audited orders to ensure clean claim billing.
- Participated as a member of MED-EL audit team and PIT crew (Process Improvement team)
- Loaded and updated Insurance profiles in the billing system.
- Ran Daily close report process to ensure accurate revenue of electronic claims processing and manual paper claims submissions.
- Review and mail paper claims that need to be sent manually.
- Maintained same duties as Senior Reimbursement Specialist for my direct region.
Senior Reimbursement Specialist
04.2017 - 03.2019
- Promoted to a Senior role.
- Maintained same duties as previous role.
- Became a subject matter expert on daily processes enabling me to mentor team members.
Reimbursement Specialist
03.2015 - 04.2017
- Maintained the same responsibilities as the previous role with more experience and knowledge.
Reimbursement Representative
10.2013 - 03.2015
- Provided direct support to clinics and patients/customers regarding insurance coverage, acquired authorizations, and submitted appeals for insurance approval.
- Verified claim status, and coding issues related to cochlear implant products.
- Assisted Accounts receivable staff in researching unpaid claims related to eligibility verification, prior authorizations, and other denials.
- Claim filing and processing knowledge of public and private payers, including primary and secondary filings.
- Entered invoices/charges into claims processing reimbursement software (Greenway Intergy).
- Working knowledge of ICD-10, HCPCS, and CPT code classifications.
- Prepared and quality-checked daily keyed claims for electronic and manual insurance billing.
- Compiled Accounting reports for payments and write-offs to accurately reflect revenue.
- Verified monthly invoice reports to ensure all invoices have been processed.
- Assisted in training new staff in reimbursement processes.
- Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
BLUE CROSS BLUE SHIELD OF NORTH CAROLINA
12.1996 - 12.2011
Operations Specialist
01.2009 - 01.2011
- Provided cross-functional support to NC State Health Plan and NC Health Choice Claims operational functions, including one-on-one training, auditing, fulfillment, and/or root cause analysis.
- Served as subject matter expert for employees’ inquiries about work processes, procedures, products, and policies.
- Served as the team's first level of resolution for complex claims.
- Handled all OCR (Optical Character Recognition) claim validation queues.
- Provided daily inventory and productivity reports for review by upper management.
- Developed reference tables for use by claims processors to drive efficiency in daily tasks and updated Job Aides to ensure accurate processing of claims.
- Cross-trained team members and helped them improve efficiency and cut down on idle time; trained temporary staff on work processes and procedures.
- Audited paper and live claims daily to provide feedback to ensure quality claims processing.
Claims Specialist
01.2001 - 01.2009
- Researched and coordinated payment for HCFA, UB, and Subscriber submitted claims that indicate Medicare as primary payer.
- Processed real-time adjustments and updates to resolve claim payment errors.
- Managed accurate and timely adjudication of claims and administered claims per contractual benefits and health care policies.
- Expert knowledge in reading Explanation of Benefits (EOBs) from various insurance companies; thorough knowledge of CPT, HCPCS, and ICD-9 codes.
- Consistently ensured critical compliance with HIPAA privacy standards.
Front End Claims Processor
01.1996 - 01.2001
- Data Entered HCFA Medical Claims and Member Submitted Claims.
Education
Bachelor of Science - Computer Networking, Minor in Business
STRAYER UNIVERSITY
06.2008
Skills
- HCPCS/CPT, ICD-10
- National Provider Identifier
- Multi-tasking/Time management
- Microsoft Dynamics (Navision database)
- Microsoft Office (Word, Excel, Outlook)
- Practice Analytics Software
- Extensive Medicare/Medicaid knowledge
- Medical billing experience
- Account reconciliation specialist
- Billing systems and software experience (Waystar, Change, and Emdeon Clearinghouses)
- Billing systems and software (Credible and Greenway/Intergy)
Timeline
Billing Specialist
National Counseling Group
12.2021 - Current
Senior Reimbursement Lead
07.2021 - 12.2021
Reimbursement Lead
03.2019 - 06.2021
Senior Reimbursement Specialist
04.2017 - 03.2019
Reimbursement Specialist
03.2015 - 04.2017
MED-EL CORPORATION
10.2013 - 12.2021
Reimbursement Representative
10.2013 - 03.2015
Operations Specialist
01.2009 - 01.2011
Claims Specialist
01.2001 - 01.2009
BLUE CROSS BLUE SHIELD OF NORTH CAROLINA
12.1996 - 12.2011
Front End Claims Processor
01.1996 - 01.2001
Bachelor of Science - Computer Networking, Minor in Business
STRAYER UNIVERSITY
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