Crystal Warrington
Alpharetta,GA
Summary
Detail-oriented and results-driven Healthcare Claims Specialist with 7 years of experience in claims processing, denials management, and appeals in fast-paced healthcare environments. Adept at interpreting medical documentation, verifying insurance coverage, and ensuring compliance with payer policies, and HIPAA regulations. Recognized for accuracy, efficiency, and strong problem-solving skills that reduce claim errors, and improve reimbursement timelines.
Overview
9
9
years of professional experience
Work History
Insurance Verification Specialist
Emory University Healthcare
Atlanta, GA
11.2021 - 09.2025
- Obtained prior authorizations and pre-certifications as required by the insurance plan.
- Contacted insurance companies to verify primary and secondary insurance for both in-network and out-of-network coverage, and claims inquiries.
- Worked closely with payers to address denials and partial payments.
- Accurately coded patient diagnoses and procedures using the ICD-10 and CPT coding systems to generate accurate patient bills.
- Resolved routine patient billing inquiries and issues.
- Verified insurance eligibility for patients utilizing EPIC.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
Claims Representative - Remote
Centauri Health Solutions
Cleveland, Ohio
10.2018 - 12.2021
- Processed claims by reviewing documentation and verifying eligibility criteria.
- Filed appeals on behalf of customers when necessary after denial of a claim due to insufficient evidence.
- Coordinated with medical providers to obtain supporting documentation for claims.
- Evaluated claim disputes and provided recommendations for resolution procedures.
- Maintained accurate records of all correspondence related to claim inquiries.
- Resolved complex discrepancies in policyholder files to facilitate accurate claim processing.
Patient Access Representative III
Piedmont Healthcare
10.2016 - 10.2018
- Greeted patients and visitors, responsible for patient registration and admission.
- Input demographics for new patients utilizing EPIC.
- Collected co-pays, deductibles, self-pays and provided all necessary forms for completion.
- Verified insurance eligibility with insurance companies.
- Prepared Medicare, self-pay and surgical estimates.
- Trained others in the department to perform patient access responsibilities as necessary.
Education
High School Diploma -
William Howard Taft
The Bronx, NYSkills
- Claims processing
- Insurance verification
- Time management abilities
- Team collaboration
- Effective communication
- Problem solving
Timeline
Insurance Verification Specialist
Emory University Healthcare
11.2021 - 09.2025
Claims Representative - Remote
Centauri Health Solutions
10.2018 - 12.2021
Patient Access Representative III
Piedmont Healthcare
10.2016 - 10.2018
High School Diploma -
William Howard Taft
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