Summary
Overview
Work History
Education
Skills
Timeline
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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
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
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
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, VA

Associate of Applied Science - Nursing

Tidewater Community College
Norfolk, VA

Skills

  • 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

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Kerry Horton