Summary
Overview
Work History
Education
Skills
Timeline
Generic

Patrick Horn

Tucson,AZ

Summary

Ambitious, career-focused job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Overview

9
9
years of professional experience

Work History

Claims Analyst

Centene
10.2019 - Current
  • Strong computer knowledge with over 5 years' experience working with multiple monitors and claim systems
  • Maintain records, files and documentation as appropriate for each claim
  • Strong knowledge of Medicaid and Medicare claims
  • Review of charges, access of multiple computer systems via VPN, using payment and denial codes with department guidelines and standards
  • Point of Contact for co-workers in regards to questions on claims
  • Advancement in processing of recoupment/appeals
  • Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
  • Point of Contact for Health plans process of handling claims.
  • Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
  • Streamlined appeals process for increased efficiency through consistent tracking and monitoring of cases.
  • Enhanced appeal resolution rates by thoroughly reviewing and analyzing case documentation.
  • Maintained comprehensive knowledge of regulatory guidelines to ensure compliance within the appeals department.

Collection Specialist

Shared Services Center
01.2017 - 10.2019



  • POC for new employees for help resolving accounts, documentation requirements, technical issues and general team support
  • Responsible for handling five facilities claims and submitting the necessary follow up to finalize and close accounts
  • Main contact, per insurance providers request, BCBS Indian Health due to ability to work accounts
  • Streamlined the collections process for increased efficiency through regular review and updating of procedures.
  • Improved client relations by effectively managing collection calls and addressing customer concerns.
  • Monitored accounts receivable aging reports, proactively initiating collection efforts on past-due accounts to minimize losses.
  • Developed strong relationships with external agencies to facilitate efficient coordination during escalated collection efforts or legal proceedings involving delinquent accounts.
  • Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
  • Examined claims forms and other records to determine insurance coverage.

Pharmacy Tech Trainee

Convergys
01.2016 - 01.2017
  • Non-Dispensing Pharmacy
  • Handled calls for refills and status of prescriptions
  • Checked pricing and inventory of certain prescriptions
  • Submitted faxes to doctors for new prescriptions
  • Contacted resolution Center for certain Third-Party Rejections.
  • Improved first-call resolution rates with thorough issue analysis and effective problem-solving techniques.
  • Managed high call volumes while providing exceptional customer support and maintaining professional composure.

Department Lead/Machinist

Halyard Health
01.2015 - 01.2016
  • Medical Lab Assembler for oral care department; clean room environment procedures
  • Prepping of inventory; boxes, lids, cups, bags, trays
  • Including Re-word
  • Data entry including daily file and record documentation
  • Coordinate and maintain supply inventory for daily production runs
  • Coordinated with the maintenance department for machine failure
  • Trained in Personal Protection Equipment, Hazardous Material
  • Monitored tote shelf life in compliance to be able to use
  • Logged maintenance issues to the Maintenance Department
  • Measuring level of peel lid testing and pressure testing.
  • Led team to achieve high performance standards through consistent coaching and feedback.
  • Oversaw daily operations of the department, ensuring smooth workflow and adherence to deadlines.
  • Collaborated with other departments to improve interdepartmental communication, enhancing overall organizational effectiveness.

Education

Diploma -

Sahuaro High School
01.2011

Skills

  • Claims Review
  • Document Workflow
  • Claims History Analysis
  • Complaint Resolution
  • Customer Service Excellence
  • Customer Insight
  • Computer Skills
  • Critical Thinking
  • Coaching and Mentoring
  • Time Management
  • Detail Oriented
  • Communication Skills

Timeline

Claims Analyst

Centene
10.2019 - Current

Collection Specialist

Shared Services Center
01.2017 - 10.2019

Pharmacy Tech Trainee

Convergys
01.2016 - 01.2017

Department Lead/Machinist

Halyard Health
01.2015 - 01.2016

Diploma -

Sahuaro High School

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Patrick Horn