Che Callender
Saint Michael,MN
Summary
Detail-oriented and dedicated reimbursement and health policy professional with 7+ years of experience in payer operations, Medicare/Medicaid policy, and compliance. Demonstrated ability to interpret and ensure adherence to regulatory requirements while collaborating with cross-functional teams to support labeling compliance and risk management strategies. Proven success in analyzing complex healthcare cases to align strategic objectives with operational goals.
Overview
8
8
years of professional experience
Work History
Provider Eligibility and Compliance Specialist
MN State-DHS
St. Paul, MN
08.2024 - Current
- Analyze Medicaid and public payer eligibility, coverage policies, and reimbursement pathways to ensure compliance with federal and state healthcare regulations.
- Interpret Medicare, Medicaid, and managed care payer policies to determine coverage eligibility and reimbursement outcomes for complex healthcare cases.
- Educate internal stakeholders on coverage requirements, eligibility rules, and reimbursement processes to ensure consistent policy interpretation and execution.
- Utilize advanced Excel-based data analysis to monitor compliance metrics, identify reimbursement trends, and support program oversight.
Eligibility Specialist
Washington County
Stillwater, MN
11.2023 - 08.2024
- Supported development and review of CMS-aligned reimbursement policies and Standard Operating Procedures (SOPs) for clinical research billing and compliance.
- Conducted policy analysis to ensure alignment with FDA regulations, payer requirements, clinical guidelines, and IRB standards, reducing policy review time by 25%.
- Delivered training sessions to 100+ employees and leadership stakeholders on policy submission processes, documentation standards, and billing compliance requirements.
- Provided comprehensive explanations of program rules and potential outcomes, fostering client understanding and involvement while referring any potential welfare fraud situations.
Clinical Administrative Coordinator
Optum- United Health Group
Eagan, MN
11.2021 - 11.2023
- Conducted comprehensive compliance audits across Medicare, Medicaid, HMOs, PPOs, and self-funded employer plans to ensure adherence to billing regulations.
- Interpreted payer coverage criteria, coding guidelines, and payment requirements to support accurate billing practices and reduce claim denials by 15%.
- Analyzed benefit design and reimbursement pathways for 50+ health plans, achieving 95% accuracy in determining coverage eligibility and payment outcomes.
- Partnered with hospitals, physicians, and billing departments to optimize documentation processes and reduce reimbursement barriers.
Complex Customer Service Advocate
United Healthcare
Minnetonka, MN
03.2018 - 11.2021
- Proactively identified children with complex needs and connected them to vital medical, behavioral, and pharmacy support services.
- Delivered personalized advocacy and resolved benefit issues for over 150 assigned families, ensuring access to essential healthcare resources.
- Championed member needs by intervening with care providers and guiding families through critical transitions impacting benefits and reimbursement.
Education
Dual Master’s Degree - Healthcare Administration and Business Administration
University of Scranton
Scranton, PA08.2023
Bachelor of Health Science - undefined
University of West Florida
Pensacola, FL12.2014
Skills
- Regulatory Compliance
- Risk Assessment and KPI
- Project Management
- Patient File Audits
- Conflict management
- Electronic Health Records
- Ethics management
- Analytical Skills
- Health insurance policies
- Quality Assurance
- Microsoft Office Suites
- Time Management
- Internal auditing
- Sanctions compliance
CAREER HIGHLIGHTS
- Strategic Regulatory & Payer Alignment: Expertly navigated complex reimbursement landscapes by interpreting Medicare, Medicaid, and private payer policies to ensure 100% alignment with CMS and FDA regulations.
- Revenue and Compliance Optimization: Utilized advanced data analytics to identify reimbursement trends and audit clinical billing practices across 50+ health plans, including HMP, PPO, and self-funded models and reduced claim denials by 15%.
- Compliance Committee: Partnered with compliance and ethics committee members to identify potential risk areas and develop new policies to mitigate risks. Developed CMS-aligned Standard Operating Procedures (SOPs) and delivered comprehensive training to 50+ stakeholders on reimbursement requirements.
LEADERSHIP EXPERIENCE
- Executive Committee Member, Minnesota Alliance for Volunteer Advancement, St. Paul, MN | July 2023-Present
- Give Us Wings, Executive Board Member, St. Paul, MN | July 2023-Present
Timeline
Provider Eligibility and Compliance Specialist
MN State-DHS
08.2024 - Current
Eligibility Specialist
Washington County
11.2023 - 08.2024
Clinical Administrative Coordinator
Optum- United Health Group
11.2021 - 11.2023
Complex Customer Service Advocate
United Healthcare
03.2018 - 11.2021
Bachelor of Health Science - undefined
University of West Florida
Dual Master’s Degree - Healthcare Administration and Business Administration
University of Scranton