Summary
Overview
Work History
Education
Skills
References
Timeline
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Ericka Kirton

Wimauma,FL

Summary

To find a rewarding position that will utilize my skills and experience. Claims Examiner with deep knowledge of healthcare claims industry. Solid abilities in developing objectives and strategies to settle medical claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.

Overview

22
22
years of professional experience

Work History

Senior Medical Claims Examiner

NTTDATA
09.2013 - 07.2023
  • Researches and process institutional and professional Medicare and Medicaid claims
  • Serves as a mentor to less experienced peers and acts as a resource to resolve more complex claims
  • Researched and resolved complex medical claims issues to support timely processing.
  • Process adjustments related to projects or provider disputes providing timely follow-up provider call backs
  • Review ICD-9 and CPT codes to ensure claims pay accurately
  • Identify root-cause issues to ensure enterprise solutions and communicate findings as needed
  • Participates in all formal and informal training opportunities.

Senior claim examiner

Humana
02.2016 - 07.2017
  • Process Florida Medicare claims
  • Determining cause of claim error
  • Analyzing data on adjustment, overpayments and returned checks
  • Work adjustment and special spreadsheets projects
  • Manually touch every claim to make sure all claim are paid and adjusted correctly there is no auto adjudicate.

Claims Analyst II

Amerigroup
10.2012 - 09.2013
  • Process intermediate and high complexity Medicaid, COBA, and COB insurance claims
  • Audit high dollar claims
  • Read, interpret, and apply contract terms to claims processing
  • Assist in training employees
  • Complete special projects as assigned.
  • Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
  • Reduced claims processing time by implementing efficient analytical techniques and strategies.
  • Collaborated with cross-functional teams to develop best practices for claim handling procedures.

Technical Claims Specialist

Coventry
05.2008 - 06.2012
  • Process workers compensation insurance claims
  • Interpret and process adjustments in accordance with company policy and procedures
  • Complete special projects as assigned.

Claims Associate

United Healthcare
11.2007 - 04.2008
  • Process basic and intermediate complexity commercial and COB insurance claims
  • Process same day voids
  • Process adjustments on claims that have been over or under paid.

Customer Contact Rep

Progressive Insurance
08.2001 - 07.2007
  • Responsible for taking incoming calls from Insurance Agents and customer
  • Taking payments, explaining billing documentation sent and received
  • Made endorsement changes to policy
  • Website navigation assistance for site specifically designed for agent use
  • Quickly resolved customer issue by finding option to help their needs
  • Used software applications to track, and gather information and answer inquires
  • Participated in scheduled training to learn new products and processes.

Education

High School Diploma -

Jefferson High School
Tampa
06.1987

Skills

  • Strong Communication Skills
  • Critical Thinking Capacity
  • Claims Processing Proficiency
  • HIPAA compliance awareness
  • Healthcare regulations knowledge
  • Analytical Problem Solving
  • Quality Assurance Practices
  • Medical Terminology Mastery
  • ICD-10-CM Familiarity
  • Proficiency in Xcelys and Facets claim processing platforms

References

Available upon request

Timeline

Senior claim examiner

Humana
02.2016 - 07.2017

Senior Medical Claims Examiner

NTTDATA
09.2013 - 07.2023

Claims Analyst II

Amerigroup
10.2012 - 09.2013

Technical Claims Specialist

Coventry
05.2008 - 06.2012

Claims Associate

United Healthcare
11.2007 - 04.2008

Customer Contact Rep

Progressive Insurance
08.2001 - 07.2007

High School Diploma -

Jefferson High School

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Ericka Kirton