Casey Anderkin
Louisville,KY
Summary
Motivated professional with experience in clinical support and provider relations, Humana Medicare products and CMS guidelines, seeking a remote role to to improve provider and member satisfaction and operational efficiency.
Overview
18
18
years of professional experience
Work History
UM Administration Coordinator 2
Humana
Louisville, KY
02.2011 - Current
- Managed provider relations by communicating directly with healthcare facilities to obtain required documentation, resolve issues, and ensure timely case progression.
- Ensured compliance with CMS guidelines and regulatory timeframes, supporting accurate and timely determinations for facilities and members.
- Coordinated with provider facilities to obtain and verify documentation, ensuring compliance and CMS requirements.
- Partnered cross-functionally (fax processing, discharge planning, peer-to-peer, provider disputes, letters) to support case progression, communication and regulation.
- Conducted case analysis and documentation review, upholding high-quality standards across FER, letters, faxes, P2P, discharge planning, and provider dispute workflows.
- Coordinated provider communications and P2P reviews with medical directors to support outcomes.
- Utilized multiple systems GCX, PFP, Sharepoint to manage case and provider data.
- Analyzed data trends to leadership to support data-driven decision making and performance improvements.
- Piloted new processes (FER, P2P) to support cross-functional teams and enhance operational effectiveness.
Agent Support Representative
Humana
Louisville, KY
06.2008 - 02.2011
- Assisted Humana and independent sales agents with policy questions, eligibility clarifications, and benefit guidance to enhance agent effectiveness.
- Addressed routine service issues via phone, email, and case notes to ensure timely resolution and customer satisfaction.
- Utilized knowledge of CMS guidelines and workflows to ensure compliance and streamline operational processes.
Education
Bachelor of Arts - Radio/Television Operations
Western Kentucky University
Bowling Green, KY05-2007
Skills
- Utilization management
- CMS compliance
- Utilization review
- Case documentation review
- Provider relations
- Data analysis
- Cross-functional coordination
- Workflow coordination
- Effective communication
Timeline
UM Administration Coordinator 2
Humana
02.2011 - Current
Agent Support Representative
Humana
06.2008 - 02.2011
Bachelor of Arts - Radio/Television Operations
Western Kentucky University