Summary
Overview
Work History
Education
Skills
Timeline
Generic

Monae Gilliam

Raleigh

Summary

Healthcare operations and data management professional with 7+ years of experience in clinical documentation, prior authorization review, and administrative support. Skilled in analyzing healthcare data, managing benefit packages, and ensuring financial accuracy and compliance with HIPAA and federal guidelines. Experienced in team leadership, process improvement, and cross-functional collaboration. Seeking to contribute expertise in healthcare administration and finance to WakeMed Health & Hospitals.

Overview

7
7
years of professional experience

Work History

Team Lead – Medicare Claims

Cigna Medicare
08.2024 - Current
  • Lead a team of 15+ agents, ensuring adherence to schedules, timekeeping accuracy, and compliance with company and federal standards.
  • Serve as a knowledge resource and mentor to Patient Account Representatives, providing training and assistance as needed.
  • Serve as Supervisor on Duty, overseeing daily operations, monitoring quality, and resolving escalations.
  • Train and mentor staff in adherence, documentation, and process accuracy.
  • Track and report on billing and collection performance metrics; assist in identifying trends and recommending process improvements

Claims Representative II

Cigna
07.2022 - 08.2024
  • Review and process claims to ensure accuracy, completeness, and compliance with internal and external standards
  • Conduct timely follow-up on outstanding or unpaid claims to reduce aging accounts receivable and ensure proper reimbursement
  • Ensure all billing and collection activities are conducted in compliance with hospital policies, payor contracts, and government regulations.

Claims Representative I

Cigna
01.2019 - 08.2024
  • Prepare and submit hospital claims in accordance with payor-specific billing guidelines and regulatory requirements
  • Analyze and resolve denied claims by researching the denial reason, taking corrective action, and resubmitting claims when appropriate
  • Maintain detailed documentation of actions taken on each account.

Education

Bachelor of Science - Mass Communications

01.2019

Skills

  • Healthcare & Insurance Administration
  • Prior Authorizations, Referrals, Benefit Packages
  • Financial Documentation & Data Accuracy
  • Regulatory Compliance: HIPAA, GCP, Federal Guidelines
  • Clinical Documentation & Terminology
  • Investigative & Analytical Skills
  • Team Leadership, Training & Mentorship
  • Project Coordination & Deadline Management
  • EMR Systems, Excel & Data Reporting
  • Remote Work & Process Improvement

Timeline

Team Lead – Medicare Claims

Cigna Medicare
08.2024 - Current

Claims Representative II

Cigna
07.2022 - 08.2024

Claims Representative I

Cigna
01.2019 - 08.2024

Bachelor of Science - Mass Communications

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Monae Gilliam