Kerry Horton
Summary
Experienced Medical Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 10 years of experience and willingness to take on any challenge.
Overview
10
10
years of professional experience
Work History
Claims Analyst II
Sentara Healthcare
Norfolk, VA
07.2017 - Current
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Verified claim data correctness in preparation for processing.
- Reviewed history records to determine benefit eligibility for services.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Analyzed contracts and claim systems to apply appropriate benefit amounts.
- Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Organized information by using spreadsheets, databases or word processing applications.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Modified and updated existing policies and claims to reflect change in beneficiary, amount of coverage or type of insurance.
- Handled and processed variety of claims, including Medical and Behavioral/Mental Health and Wavier.
Authorization Appointing Representative
Kelly Services
Hampton, VA
11.2014 - 07.2017
- Accessed patient information through various software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Obtained proper authorization and identification to release confidential medical records.
- Registered patients by verifying records to update computer system and patient charts.
- Documented and managed patient information in computer system.
- Scheduled and confirmed patient appointments with patients and healthcare professionals.
- Referred patients to appropriate professionals and services.
- Obtained insurance verification and authorization to submit financial clearance of patient accounts.
Medicaid Eligibility Specialist
Fanuiel
Hampton, VA
05.2014 - 11.2014
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Answered questions and responded to inquiries to deliver high level of service to patients.
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
- Informed applicants of other agencies providing useful or related assistance.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Education
Associate of Applied Science - Nursing
Thomas Nelson Community College
Hampton, VAAssociate of Applied Science - Nursing
Tidewater Community College
Norfolk, VASkills
- Claims Processing
- Information Confidentiality
- Claims Evaluation
- Decision Making
- Critical Thinking
- Attention to Detail
- Time Management
- Policy and Procedure Explanations
- Payment and Investigation Escalations
Timeline
Claims Analyst II
Sentara Healthcare
07.2017 - Current
Authorization Appointing Representative
Kelly Services
11.2014 - 07.2017
Medicaid Eligibility Specialist
Fanuiel
05.2014 - 11.2014
Associate of Applied Science - Nursing
Thomas Nelson Community College
Associate of Applied Science - Nursing
Tidewater Community College