Caitlyn Toby-Henderson
Sellersburg,IN
Summary
Registered Nurse with Auditing/Coding, Payment Integrity, Project Management experience. Collaborates effectively with multidisciplinary teams and stakeholders to accomplish dynamic initiatives and meet organizational goals.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Senior Project Manager
Humana
Sellersburg, IN
08.2024 - Current
- Tracking and reporting on all financial savings, claim selections, and variances to leadership for all new concepts.
- Creating and validating new concept rules and queries for accurate claim selection.
- Triaging and vetting new concepts submitted and processing data requests for new concept opportunities.
- Providing consistent rule updates and submitting any needed rule modifications.
- Designed a PowerBI and Sharepoint site with Data Team to facilitate tracking and collaboration of new concepts between departments.
Medicaid SME, Clinical
Humana
10.2023 - 08.2024
- Reviewed Medicaid contract language and state regulations to identify opportunities for: increased savings through the implementation of audit programs and/or rule creation, improving the provider experience, reducing administrative costs by accurately selecting claims for medical records review, ensuring compliance in handling provider claims and partnering with our market leaders.
Provider Payment Integrity- Clinical Audit
Humana
10.2021 - 10.2023
- Collaborating with vendors, stakeholders, and across multiple departments to implement natural language processing (NLP) software.
- Provide clinical guidance on medical record data, concept mapping, and rule development.
- Assisted multiple departments with process improvement work to help Humana meet the $2.5M goal in reducing medical records.
- Become Lean Certified with a $200,000 yearly cost savings project related to claim selection automation.
RN-Nurse Auditor 2
Humana
Sellersburg, IN
- Review Medical Records for accuracy while required metrics.
- Process recoupment with professional communication to providers.
- Lead and participate in meetings regarding updates on audits.
- Train and educate team members as needed.
- Proficient in Sciomine, MRM, CGX, Reimbursement coder, Select Coder, CCP2, Ehub, Humana Medical Coverage Policies.
- Strong Knowledge of CPT, ICD-10, HCPCS.
- Experience with Medicare Manuals, NCD, LCD, Articles and FDA websites
RN- Preop/PACU/PAT/PAIN
Physicians Medical Center
New Albany, IN
02.2015 - 06.2019
- 6 years of surgical nursing experience with patients of all acuity levels.
- Supervised 13 team members as Charge Nurse in fast-paced surgical setting.
RN- Preop/PACU
Clark Memorial Hospital
Jeffersonville, IN
02.2013 - 02.2015
- Administered IV's, IV medication, and obtained surgical consent.
- Educated patients on surgical procedures and aftercare for efficient recovery.
Manager, Billing and Coding
Cardiology of Kentuckiana
New Albany, IN
12.2008 - 01.2013
- Lead and supervised all coding/billing team members.
- 5 years’ experience with Medicare and Medicaid Contracts/Claims.
- 5 years’ experience with ICD/HCPCS/CPT
Education
Master's Degree - Nursing Informatics
Western Governors University
Salt Lake City, UT01.2021
Bachelor's Degree - Nursing
Western Governor's University
Salt Lake City, UT01.2019
Associate degree - Nursing
Ivy Tech Community College
Sellersburg, IN01.2014
Skills
- Strong clinical judgment
- Multitasking
- Excellent communication
- Critical thinking
- Organizational skills
- Auditing and quality assurance
Certification
- CPC - Certified Professional Coder
- Six Sigma Lean Certificate
Timeline
Senior Project Manager
Humana
08.2024 - Current
Medicaid SME, Clinical
Humana
10.2023 - 08.2024
Provider Payment Integrity- Clinical Audit
Humana
10.2021 - 10.2023
RN- Preop/PACU/PAT/PAIN
Physicians Medical Center
02.2015 - 06.2019
RN- Preop/PACU
Clark Memorial Hospital
02.2013 - 02.2015
Manager, Billing and Coding
Cardiology of Kentuckiana
12.2008 - 01.2013
Bachelor's Degree - Nursing
Western Governor's University
Associate degree - Nursing
Ivy Tech Community College
RN-Nurse Auditor 2
Humana
Master's Degree - Nursing Informatics
Western Governors University