Janie White
Apopka,FL
Summary
Health Sciences Pre-Clinical graduate with extensive experience in healthcare operations, billing, and insurance resolution, including Medicare and Medicaid. Demonstrated expertise in vendor management and customer service, with a track record of enhancing process efficiency in healthcare and property management. Highly motivated with strong adaptability and interpersonal skills, capable of mastering new systems independently and effectively. Committed to delivering results and embracing new challenges in dynamic environments.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Senior Audit and Compliance Coordinator- Revenue cycle Operations
Optum/UnitedHealth Group
Eden Prairie, MN
03.2022 - Current
- Audit medical claims and documentation for Medicare and Medicaid compliance, addressing discrepancies and billing errors.
- Coordinated and submitted Medicare, Medicaid, and commercial audits across 18+ hospitals using DDE, EDM, eFR, Cerner, and Citrix.
- Tracked audit progress to ensure timely vendor and site submissions while escalating delays to leadership.
- Managed comprehensive correspondence with auditing bodies such as RAC, MAC, QIC, CERT, UPIC, OIG, QIO, and ALJ.
- Collaborated with Clinical Educators to communicate policy updates and audit best practices.
- Served as primary liaison between hospital sites and auditing entities to resolve compliance issues.
Senior Resolution Specialist
CVS Healthcare
Orlando, FL
01.2020 - 12.2022
- Resolved complex inquiries regarding claims and Medicare benefits efficiently.
- Reduced training time by 50% through expertise as subject matter expert.
- Trained new staff on systems including AS400 and RxClaims for Medicare D and commercial claims.
- Acted as primary contact for escalated client issues, applying advanced problem-solving skills.
- Collaborated with leadership to assess education needs, delivering coaching on Medicare Part D management.
Education
Bachelor of Science - Health Science - Pre Clinical Track
THE UNIVERSITY OF CENTRAL FLORIDA -UCF
Orlando, FL08.2020
Skills
- Medicare compliance
- Audit management
- Policy development
- Data analytics
- Claim adjudication
- Risk assessment
- Attention to detail
- Conflict resolution
- Team collaboration
- Analytical mindset
- Conducting audits
- Internal audits
- Staff training
- Audit compliance
- Client relationship management
- Problem solving
Certification
Project Management Professional (PMP), Application Approved, Exam Preparation in Progress
Languages
English
Native/ Bilingual
Spanish
Professional
Timeline
Senior Audit and Compliance Coordinator- Revenue cycle Operations
Optum/UnitedHealth Group
03.2022 - Current
Senior Resolution Specialist
CVS Healthcare
01.2020 - 12.2022
Bachelor of Science - Health Science - Pre Clinical Track
THE UNIVERSITY OF CENTRAL FLORIDA -UCF
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