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, IL01.1995
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
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