Adrienne Gilkey
Louisville
Summary
Dynamic, results-oriented professional with expertise in payment integrity and process improvement, adept at analytical problem solving and collaborative teamwork Recognized for driving innovation and delivering impactful solutions through analytical thinking and creativity. Proven expertise in managing projects effectively while fostering collaboration within diverse teams to achieve common objectives. Committed to continuous learning and adept at adapting to fast-paced environments, consistently aligning efforts with organizational goals. Strong track record of leveraging skills to enhance productivity and support strategic initiatives.
Overview
18
18
years of professional experience
Work History
Senior Payment Integrity Professional
HUMANA, INC.
10.2025 - Current
- Led project to a 51K quarterly reduction in rework of claims, resulting in $340K in cost avoidance.
- Piloted a 3-month project that increased the hit rate percentage from 85% with an estimated savings of 87k
- 19 direct reports from Sagility
- Inventory management and Process updates
Payment Integrity Professional 2
MODB
01.2022 - 10.2025
- Design Ambulance, Physician and several Medicare and Medicaid Outpatient Pricer projects to reduce spending with a Vendor savings of $1M utilizing the automation process with 700+ hours of manual work eliminated for the 1st 6 months of 2025.
- 300k+ claims set up through automation process since 8/2024
- Research and collaboration with other departments helped to determine vendors set up 2575 invalid claims for a total of $196,269.35 of invalid recoupments.
Claims Research and Resolution Specialist 4- Provider Payment Resolver
10.2020 - 01.2022
- Conduct monthly in SOC calls with leaders and providers to discuss concerns and deliver resolutions
- Identify and analyze trends causing overpayments
Claims Research and Resolution Specialist 2- Claims Cost Management
10.2019 - 10.2020
- Support providers with Financial Recovery questions via Phone, Email and Availity
- Independently research claims to identify Financial Recovery Overpayments
- Assist providers with their concerns and offer solutions
Process Improvement Professional 2- Claims Process Organization
08.2018 - 10.2019
- Generate weekly reports and submit IPAR's based on findings
- Collaborate with providers and internal associates weekly to identify and root cause trends
- Succeed in a project of eliminating 2000+ claims that erroneously denied payment for IPA
Analyst - Post-pay and Prepay Strategy and Analytics
07.2015 - 08.2018
- Research more than 30 queries weekly to interpret logic and intent
- Root analysis to increase the Financial Recovery query hit rate percentage
- Formatted audit instructions for the Post Pay audit teams
Financial Recovery Global Audit and Validation Specialist
01.2014 - 07.2015
- Train associates weekly on new audit projects
- Analyze claim data and logic to create audit instructions
- Reviewed the adjudication of claims and manually set up financial recoupments in CAS
Specialist - Contract Interpretation System (CIS)
04.2012 - 01.2014
- Interpret contract reimbursement language to translate and build into the CIS application
- Educate Market Reps and internal departments on reimbursement methodologies
- Collaborate with leadership to create a Mentor document for KY Medicaid/CareSource process
Specialist -Medicare Claims
Humana, Inc.
10.2010 - 04.2012
- Front End and Pricer CAS processing
- Manually processed Medicare claims using the CAS system and CIS application
- Received Star Award for training employees and interim Team Lead as needed
Manager
US Bank
02.2008 - 10.2010
- Perform daily, weekly and monthly audits on cash drawers
- Pass all surprise Quality Audits quarterly
- Assist customers with opening accounts, cash deposit, credit cards, safe deposit boxes
Education
Certified Professional Coding -
MedCerts
12-2025
Bachelor of Science - Business Administration And Management
Indiana Institute of Technology
Fort Wayne, IN06-2019
Skills
- Claims analysis
- Microsoft Office
- Work with data mining vendors to support payment integrity initiatives
- Work independently and in group settings
- Strong attention to detail
- Strategic decision-making
- Analytical problem
- Provider payment analysis
- Analytical research skills
- Process Improvement
- Critical thinking
- Flexible and adaptable
- Dependable and responsible
- Organization and time management
- Problem resolution
Timeline
Senior Payment Integrity Professional
HUMANA, INC.
10.2025 - Current
Payment Integrity Professional 2
MODB
01.2022 - 10.2025
Claims Research and Resolution Specialist 4- Provider Payment Resolver
10.2020 - 01.2022
Claims Research and Resolution Specialist 2- Claims Cost Management
10.2019 - 10.2020
Process Improvement Professional 2- Claims Process Organization
08.2018 - 10.2019
Analyst - Post-pay and Prepay Strategy and Analytics
07.2015 - 08.2018
Financial Recovery Global Audit and Validation Specialist
01.2014 - 07.2015
Specialist - Contract Interpretation System (CIS)
04.2012 - 01.2014
Specialist -Medicare Claims
Humana, Inc.
10.2010 - 04.2012
Manager
US Bank
02.2008 - 10.2010
Certified Professional Coding -
MedCerts
Bachelor of Science - Business Administration And Management
Indiana Institute of Technology