Health Information Communication Skills
Resume:
JANET E. GILKEY
Riverview, FL 33579
E-mail: ad2am7@r.postjobfree.com
OBJECTIVE:
EMPLOYMENT:
Humana Inc. Tampa, Florida
Claims Research Unit, July 2014 to January 2024
Review and correct any discrepancies in payment to provider or member.
Handle all claims rework and reversals
Reprocess and pay claims
Apply any financial recovery needed in reprocessing claims.
Maintain strict confidentiality of company and personal health information at all times.
Examine provider contracts
Utilize strong organizational and written communication skills.
Calculate adjustments and make necessary changes to the claims
Utilize Medicare and Medicaid pay schedules
Humana Inc, Louisville, Kentucky
Claims processor and Pre-Pay Auditor, Oct. 15, 2002 to July 2014
Reviewed and resolved billing, invoice and payment discrepancies for hospital and physician claims to make sure information is correct.
Maintained financial audit records to ensure duplicates are not made.
Audited records to determine root cause and offered resolutions by meeting business objectives in a timely manner.
Identified and reported inconsistencies relative to adjudication of Medicaid, Medicare and Commercial claims for contract compliance to enhance audit production and to meet goals.
Maintained strict confidentiality of company and personal health information at all times.
Examined provider contracts
Utilized strong organizational and written communication skills.
Calculated adjustments and make necessary changes to the claims
Utilized Medicare and Medicaid pay schedules
Midway College, Midway, Kentucky
Director of Residence Life, August 1998-June 1999
Principal officer for residence hall day-to-day management
Directed the hiring/training/supervision of professional staff.
Facilitated roommate counseling and conflict management.
Coordinated summer/conference-housing assignments.
Prepared and managed residence hall budgets and expenditures.
ACCOMPLISHMENTS:
Member of Alpha Kappa Alpha Sorority Inc.
Served on Nominating Committee for WKU Distinguished Alumni.
Served on the University of Louisville’s Judicial Board.
Co-authored an article published in the Student Affairs journal.
Member of the National Association for Student Personnel Administrators.
Taught Freshman Studies Course at Midway College.
EDUCATION:
University of Louisville, Louisville, Kentucky
Master of Education and Counseling May 10, 1997. GPA 3.9
Western Kentucky University, Bowling Green, Kentucky
Bachelor of Business Administration 1990. GPA 2.9
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