Summary
Overview
Work History
Education
Skills
Education Certifications
Certification
Timeline
Generic

Erica Barton

Manteno,IL

Summary

Experienced Health Insurance Specialist with comprehensive industry knowledge and a proven track record in managing client relationships, resolving claims, and implementing claims management strategies. Strong focus on team collaboration and adaptability for reliable, results-driven performance. Adept at navigating complex insurance policies and regulations to provide exceptional service and support to clients. Demonstrated ability to streamline processes and improve efficiency within fast-paced healthcare environments.

Overview

27
27
years of professional experience
1
1
Certification

Work History

Insurance Specialist

Wakefield & Associates
07.2024 - Current
  • Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
  • Processed eligibility and benefits verification and authorization requests.
  • Resolved discrepancies in insurance payments by collaborating with carriers.
  • Assisted colleagues during peak workload periods, demonstrating strong teamwork and commitment to overall departmental success.
  • Minimized errors in claims submissions through regular cross-checking of CPT and ICD codes against medical documentation.

Worker’s Compensation/Personal Injury Manager/Medical Records Manager

ReLive Physical Therapy
09.2022 - 05.2024
  • Full Cycle Billing
  • Obtain Authorization for treatment plans
  • Coordinate treatment plans between Clinicians and Insurance/Attorneys
  • Contract Negotiations
  • Collaborate with outside personnel for claim follow up
  • Delegate responsibilities for Medical Records staff

EPIC Application Coordinator

Riverside Medical Center - EPIC
10.2018 - 05.2020
  • Revenue Cycle and Intake build team
  • Daily meetings with Operational Leaders and Technical Advisors to determine the best approach of the system build
  • Coordinate build of Referrals, Intake and Insurance Verifications
  • Work closely with the Clinical and Billing team for system collaboration
  • Providing continued support for Home Health Department for issue resolution past system Go Live

Medicare Billing Specialist

Riverside Home Health Care
07.2012 - 10.2018
  • Complete billing and follow up of all Medicare, MMAI and Replacement Plan Home Health Episodes
  • Daily work in Home Care Home Base, ABILITY, Availity, Passport and Florida Shared/DDE and EPIC
  • Coordinate billing for Medicare Secondary Plans
  • Research, implement and comply with CMS processing guidelines and changes
  • Work closely with the Financial Manager to resolve issues and complex cases
  • Responsible for posting payments and adjustments to accounts and EOM financial reporting to Financial Manager

Office Manager

Allergy & Asthma Associates
09.2010 - 07.2012
  • Handled sensitive information with discretion, maintaining confidentiality of company documents and personnel records.
  • Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
  • Streamlined office operations by implementing efficient filing systems and organizational strategies.
  • Maintained accurate financial records by reconciling accounts payable/receivable transactions regularly to ensure balanced budgets.
  • Enhanced team productivity by delegating tasks effectively and overseeing daily workflow.

Senior Project Consultant

CIGNA Healthcare
06.2008 - 08.2010
  • Team leader for 3 high dollar overpayment recovery coordinators
  • Responsible for tracking and meeting yearly goals set by management
  • Personally recovered $17 million from Jan-August 2010
  • Coordinated overpayment recoveries in excess of $10,000 or more for any hospital or individual provider in alpha split of A-G and S-T for entire US.
  • Coordinated daily workload and tracking for 2 teams
  • Team trainer

Senior Overpayment Audit Specialist

CIGNA HealthCare
10.2003 - 06.2008
  • Part of a team of 14 national auditors
  • Responsible for auditing contract issues and analyzing data for overpayments in 12 states
  • Complete follow up until full resolution has been made on all errors identified
  • Worked closely with other departments in identifying root cause of errors and appropriate way to resolve
  • Ability to pull data required as well as timely analysis of data
  • Work at home employee

National End to End Auditor

CIGNA Health Care
04.2003 - 10.2003
  • Complete contract audit for hospital systems in Midwest region
  • Ensure accuracy of each contract before it is loaded into claims system
  • Responsible for finalizing accurate loading through testing

South Florida Contract auditor

CIGNA HealthCare
05.2001 - 02.2003
  • Complete contract auditing for all South Florida contracts
  • Ensure accuracy of each contract before it is loaded into claims systems
  • Responsible for testing after loading by testing claims systems
  • Work at home employee

Provider Services Contracting

CIGNA HealthCare
10.2000 - 05.2001
  • Responsible for manual data transfer of contract applications to system
  • Analysis of data to determine acceptance from Medical Director
  • Provide written response of acceptance or refusal of contract application
  • Complete file transfers to Medical Director and Lead Contractor

Senior Benefit Analyst/auditor

CIGNA Healthcare
04.1998 - 10.2000
  • Process complex medical claims per guidelines and benefits responsible for meeting quality and production expectations
  • Perform random audits for a team of 30
  • Work at home employee

Education

High School -

Bradley Bourbonnais Community High School
Bradley, IL
01.1995

Skills

  • Effective documentation practices
  • Policy evaluation
  • Account management
  • Reporting skills
  • Regulatory compliance
  • Claims management
  • Reporting
  • Customer service
  • Health insurance expertise
  • Claims management systems
  • Comprehensive billing management

Education Certifications

  • Bradley Bourbonnais Community High School, 1995

Certification

Six Sigma Green Belt - 2004

EPIC Certification - 2018

Timeline

Insurance Specialist

Wakefield & Associates
07.2024 - Current

Worker’s Compensation/Personal Injury Manager/Medical Records Manager

ReLive Physical Therapy
09.2022 - 05.2024

EPIC Application Coordinator

Riverside Medical Center - EPIC
10.2018 - 05.2020

Medicare Billing Specialist

Riverside Home Health Care
07.2012 - 10.2018

Office Manager

Allergy & Asthma Associates
09.2010 - 07.2012

Senior Project Consultant

CIGNA Healthcare
06.2008 - 08.2010

Senior Overpayment Audit Specialist

CIGNA HealthCare
10.2003 - 06.2008

National End to End Auditor

CIGNA Health Care
04.2003 - 10.2003

South Florida Contract auditor

CIGNA HealthCare
05.2001 - 02.2003

Provider Services Contracting

CIGNA HealthCare
10.2000 - 05.2001

Senior Benefit Analyst/auditor

CIGNA Healthcare
04.1998 - 10.2000

High School -

Bradley Bourbonnais Community High School
Erica Barton