CHEREEIA O. BROWN

**** *. **** ******, *********, WI 53210 Cell phone 512-***-**** Personal Email: ad1k8u@r.postjobfree.com

WORK HISTORY-CENTENE CORPORATION

PROVIDER DATA ANALand YST II November 2022 to Present

Managed Health Services of Wisconsin and Meridian Health Plan Milwaukee, Wisconsin

Update the databases for Centene/s Wisconsin and Illinois health plan providers and practitioners

Responsible for the support and resolving of both provider and practitioner date issues

Processed and update submissions daily for the Wisconsin and Illinois Ambetter, Medicaid, and Medicare networks

Interact with the Contracting and Provider Relations Representatives to research provider submission conflicts

PROVIDER DATA ADMINISTRATOR/CREDENTIALING SPECIALIST February 2019 to November 2022

MHS of Wisconsin Milwaukee, Wisconsin

Updated company-wide provider database using Portico

Interacted daily with providers to validate practitioner information

Processed recreds for medical health practitioners and conducted monthly department audit

Performed monthly audits for medical and behavioral health initials and recreds

Used internet to obtain CAQH and required verification documents for credentialing

Verified practitioner practice locations to update Find-A-Provider directory

PROJECT COORDINATOR I November 2015 to February 2019

Superior Health Plan Austin/San Antonio, TX

Researched C360 inquires to identify and resolve provider set-up problems in Amisys, and contract related issues

Interacted daily with Claims, PDM, CCI, Credentialing, Network Development, Contracting and Ambetter CCI to correct and update provider pay data in Amisys using CRM and to provide clarity to claims related problems prior to processing

Responsible for overseeing, auditing, monitoring and tracking database entries for the yearly LTSS Rate Enhancement project to ensure the payment accuracy of the state assigned rate enhancements for LTSS/PAS/DAHS providers based on the yearly HHSC Rate Enhancement Guide

Initiated and developed the automated spreadsheet used to track rate enhancements for updates/changes statewide.

Trained in auditing for accuracy credentialing applications and supporting paperwork prior to forwarding for credentialing

MEMBER ADVOCATE I /COMMUNITY HEALTH WORKER February 2014 to November 2015

Superior Health Plan San Antonio, TX

Assisted the Case Managers and Social Workers through member cell phone deliveries, making well home visits and phone outreaches to assess the member’s medical, mental and physical well being. Trained members in use of phone

Outreached by phone high risk pregnant members to determine special needs

Managed the Connections Plus and Safelink Plus medical cell phones program for the state of Texas to ensure the member had phone access to medical professionals, behavioral health providers, case managers, and their support system.

Participated in conducting phone HEDIS measure assessments

Conducted face-to-face/group orientations/training with the new Case Managers and Social Workers

Conducted nationwide training conferences per the request of Corporate Office due to the success of the Texas program.

Accompanied members to medical appointments and provided assistance and resources for transportation, food and lodging

Created training materials and traveled statewide to train new Member Connections Representatives and Member Advocates

Received certification as a Community Health Work with the State of Texas

PROGRAM COORDINATOR I & II March 2011 to February 2014

Superior Health Plan Austin/San Antonio, TX

Acted in a lead capacity as a Program Coordinator II specializing in developing and conducting training programs for new Program Coordinators in Austin and San Antonio in both Medical Management Departments

Established the needed training programs, created all of the training materials and was responsible for the orienting new Program Coordinators individually and as a group. Updated and distributed all department training and reference materials

Audited assessments and made suggestions on how to improve workflow processes to our management team.

Conducted phone assessments daily for our high risk Medicaid pregnant members as a Program Coordinator I

Scheduled, tracked, and conducted follow-ups on member medical appointments.

PROVIDER SERVICES COORDINATOR/REPRESENTATIVE March 2007 to March 2011

Managed Health Services and Cenpatico Behavioral Health Milwaukee, WI, Austin, TX

Researched and resolved claim issues for Medicaid providers by phone

Initiated provider education and assisted the provider relations/claims department in correcting rejected claims

Created the training manual used to train new Provider Services Representatives before transferring to Texas.

Coordinated with the credentialing department and the provider relations department in processing provider applications for behavioral health providers credentialing nationwide.

EDUCATION

Milwaukee Trade and Technical High-Graphic Arts June 1973-1977

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