Berenice E. Elm
Overview
10
10
years of professional experience
Work History
Trainer II – Provider Engagement
Sunshine Health
Remote, USA
09.2024 - Current
- Develop and deliver training programs focused on access workflows and system navigation
- Conduct training needs analysis to identify knowledge gaps
- Lead provider engagement initiatives including Town Halls
- Analyze data and audits to design targeted education
- Collaborate with stakeholders to improve policies and workflows
- Wellcare
Provider Relations Representative
Sunshine Health
Tampa, USA
03.2021 - 01.2024
- Resolved claims, credentialing, and access issues
- Conducted provider meetings and documented action plans
- Investigated reimbursement issues
- Educated providers on referrals, claims, and policies
- Partnered cross-functionally to resolve issues
- Performed HEDIS and HBR analysis
CMS Care Coordinator
Wellcare
Tampa, USA
03.2019 - 01.2021
- Managed member/provider inquiries and resolved access issues
- Served as SME and ensured HIPAA compliance
Bilingual Sr. Clinical Admin Coordinator
UnitedHealthcare
11.2016 - 01.2019
- Collaborated with providers to streamline patient access to necessary care
- Coordinated authorizations and care services to ensure timely patient access
- Resolved customer complaints in a timely manner while upholding company standards.
- Trained employees on best practices and protocols while maintaining productivity.
Education
Bachelor of Science -
Thomas Edison State College
Jersey City, NJAssociate of Science -
Black Hawk Community College
Moline, ILSkills
- Provider engagement
- Claims & Reimbursement
- Prior Authorization
- Patient Access & Navigation
- Healthcare Compliance
- Claims management
- Cross-Functional Collaboration
- Interdepartmental collaboration
- Learning Facilitation
- HIPAA compliance
- Training program development
Accomplishments
- Educated 1,200+ providers on telehealth options, improving adoption and understanding of care delivery tools
- Delivered 600+ provider training sessions including compliance topics such as Cultural Humility
- Facilitated 50+ provider town halls strengthening engagement and alignment
- Resolved high-risk claims and operational issues preventing financial and compliance impact
- Improved provider performance using data analysis (HEDIS, HBR metrics)
- Served as Subject Matter Expert (SME) supporting team development and operations
Languages
- English
- Spanish
Timeline
Trainer II – Provider Engagement
Sunshine Health
09.2024 - Current
Provider Relations Representative
Sunshine Health
03.2021 - 01.2024
CMS Care Coordinator
Wellcare
03.2019 - 01.2021
Bilingual Sr. Clinical Admin Coordinator
UnitedHealthcare
11.2016 - 01.2019
Bachelor of Science -
Thomas Edison State College
Associate of Science -
Black Hawk Community College