Cherisse E. Hendrickson

ad1e0o@r.postjobfree.com

Summary of Qualifications

Experience in customer service

Team player- well organized and focused on numerous projects

Trained new employees on how to operate computer systems and daily routines

Resourceful and confident- can get the job done.

Education

University of Phoenix, Phoenix, AZ

Bachelor of Science- 2021

HealthCare Administration

Everest University, Orlando, FL

Associates of Science - 2014

Medical Insurance Billing and Coding

Sanford-Brown Institute Fort Lauderdale, FL Diploma in Medical Assistant - 2005

Hallandale High, Hallandale Beach, FL

High School Diploma-2000

Certification

Phlebotomy

Skills/ Software Profile

Medisoft

MS OFFICE 2000

Microsoft Word, Excel, & PowerPoint

Billing/Coding

Knowledge of insurance verifications

Collaborate MD

PBM+

Trucare

CPR +

AI-Med/EMR Software

Various Insurance websites

Medical Terminology

Data Entry

EMR

Xcelys

Professional Experience

Centene Corporation- WellCare Remote April 2023- until

Compliance Oversight Specialist - Non-Clinical

Evaluate processes and performance through audits for scalability, effectiveness, efficiency, and risk mitigation

Facilitate Health Plan and specialty care company (subcontractor) compliance through corrective action process. Identify, develop, and implement corrective actions and training materials to improve program performance based on audit outcomes

Reviews and evaluates the status and effectiveness of corrective action plans and provide comprehensive follow up to stakeholders, Senior Management, Market Compliance Oversight Committees, and/or the Audit, Finance, and Regulatory Compliance Committee of the Board of Directors.

Prepares accurate and timely formal written reports on oversight and monitoring activity findings and recommendations and ensure workpapers are properly prepared in accordance with WellCare and departmental standards, including sufficient evidentiary material exists to support oversight and monitoring activity findings.

Collaborates with and assist those within the Company and the Company’s delegated subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of our executed contracts with Government-sponsored health care programs.

Participates in the oversight of WellCare's and/or its delegated subcontractor's corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Responsibilities include conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with WellCare's contractual and regulatory requirements; collaborates with business owners and/or delegated vendors to drive remediation and assist WellCare and delegated subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements.

Centene Corporation- WellCare Orlando, FL January 2022 to March 2023

Claim Liaison II

Process claims that pend for various hold reasons to assist in the final determination on claim disposition.

Process adjustments related to projects or provider disputes providing timely follow-up provider call backs

Provider reimbursement

Identify root-cause issues to ensure enterprise solutions and communicate findings as needed

Participates in all formal and informal training opportunities

Assist with special projects as assigned or directed.

Research complex claims issues and work with all external departments, markets and providers on claims related to content

Maintain working relationships with other departments

Research SATs, QRG’s and Member’s benefits

TAT Management

Research and processes institutional and professional claims

Call providers with Denial Upholds

Maintain performance and quality standards based on established call center metrics

Centene Corporation- Sunshine Health Orlando, FL October 2019 to December 2021

Program Coordinator II

Initiate authorization requests for output or input services in keeping with the prior authorization list.

Assist claims department with complex claims determination and providing verbal to providers

Assist prior authorization department with complex claims determination and providing verbal to providers

Assist with assigning work to nurses and referral specialist, keeping a steady log of cases on a daily basis

Maintains databases and data enters assessments and authorizations into the system for downgrading urgent cases to standard

Triage queues for urgent cases

Maintain working relationships with other departments

Research claims inquiry specific to the department and the responsibility

TAT Management

Approve/Deny authorizations

Send approval/denial notifications to providers

Worked various reports

Centene Corporation- Sunshine Health Orlando, FL October 2018 to October 2019

Program Coordinator I

Initiate authorization requests for output or input services in keeping with the prior authorization list.

Assist claims department with complex claims determination and providing verbal to providers

Assist with assigning work to nurses and referral specialist, keeping a steady log of cases on a daily basis

Maintains databases and data enters assessments and authorizations into the system for downgrading urgent cases to standard

Triage queues for urgent cases

Maintain working relationships with other departments

Research claims inquiry specific to the department and the responsibility

Centene Corporation- Sunshine Health Orlando, FL July 2016 to October 2018

Referral Specialist I

Initiate authorization request for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.

Verify eligibility and benefits

Answer phone queues and process faxes within established standards

Data enters authorizations into the system

Trained new employees

Insight Global Staffing Orlando, FL

Nov 2015 to Feb 2016

Financial Assistance Representative

Explains patient’s prescription benefits and/or major medical benefits for patient’s therapy as well as financial copay assistance options

Efficiently process information to produce, verify and send outgoing documents

Enroll newly received patients from HUB into the Copay Assistance Programs following established policies and procedures and guidelines from the Manufacturer

Process claims/transactions received from Specialty Pharmacies following established policies, procedures, and guidelines from the Manufacturer

Call center environment

Dr. Mark Brooks, Orlando, Fl.

Dec 2014-Nov 2015

Medical Biller/ Payment Posting

Ensures timely, effective, and thorough management of payments posted daily

Post all line-item payments

Able to read EOB’s

Posting charges

HMO’s, Medicare, Tricare, Automobile accidents, attorney fees, statement

balance payments in patient accounts.

Referral Coordinator

Schedule all appointments, coordinating with the patients

and outside provider.

Notifications of all appointments and instructions

if needed.

Ensure all medical records, referral forms, and required

documents are submitted prior to appointments and/or

medical supply, nursing home orders.

Handled pre-certification calls from insurance companies

Orlando Healthcare Support Staffing, Orlando, FL November 2011-March 2012

Medical Assistant/Front Desk

Perform venipuncture procedure and vitals

Process specimens and laboratory reports

Perform various administrated tasks and duties

Handle medical records and prescriptions

Collect patient’s copays

MCCI OF Broward, Lauderdale Lakes, FL November 2006 - July 2011

Referral Coordinator

Obtain authorizations and schedule radiology procedures

Verify insurance and benefits

ICD-9/CPT Knowledge

Billing and Coding

Handled pre-certification calls from insurance companies

Trained new employees

MCCI OF Broward, Lauderdale Lakes, FL February 2005 – October 2006

Medical Assistant/Front Desk Coordinator

Perform venipuncture procedure and vitals

Process specimens and laboratory reports

Perform various administrated tasks and duties

Handle medical records and prescriptions

Check in and check out patients

Collect copays and gather billing information from patients

Answered incoming calls on multiline phone

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