Summary
Overview
Work History
Education
Skills
Timeline
Generic

Cheron Coleman

Summary

Results-driven Quality Control Analyst with 15 years of expertise in operational efficiency, risk assessment, compliance, and process improvement. Committed to maintaining high standards in internal auditing practices and operation management. Strong analytical skills that drives efficiency and ensures regulatory adherence. Strong collaborator who adapts to changing needs and consistently delivers results. Proven ability in data analysis, audit procedures, and financial reporting, with reputation for reliability and impact.

Overview

20
20
years of professional experience

Work History

Internal Control Analyst Associate

GDiT
03.2022 - Current
  • Conducted risk assessments to identify control weaknesses across financial processes.
  • Collaborated with cross-functional teams to ensure compliance with internal policies and regulations.
  • Developed and implemented internal control testing procedures to enhance operational efficiency.
  • Analyzed control deficiencies and recommended actionable solutions for process improvements.
  • Designed training materials to educate staff on internal controls and compliance standards.
  • Maintained comprehensive documentation of processes to support compliance and facilitate knowledge transfer.
  • Assisted with development of financial policies and controls guidance for meeting monthly, quarterly and annual oversight.

Healthcare Claims Administrator III

CSRA/GDIT
04.2015 - 03.2022
  • Supported various Medicaid providers and participants who are enrolled in the N.C. Medicaid project within NC Tracks.
  • Consistently credentialed providers, paying close attention to detail in order to make sure the given provider passes or fails the process due to violation of requirements or missing information that is needed.
  • Conducted background checks on various divisions of providers, reviewed the results, and denied when necessary based on report findings.
  • Maintained working knowledge of healthcare guidelines associated with The Center for Medicare & Medicaid Services (CMS) and Department of Health and Human Services (DHHS)
  • Utilized Microsoft Suite to create spreadsheets and reports needed to keep track of all data and workload numbers.
  • Performed online inquires using State and Federal databases such as: Provider Penalty Tracking Database (PPTD), Office of Inspector General (OIG), Lexis Nexis, Center for Medicare & Medicaid Services (CMS): Adverse Action Report.
  • Mentored junior staff in claims administration, fostering professional growth and skill development.
  • Managed high-volume escalated State correspondence, with non-live interaction (NLI) & Fast Track work process.

Credentialing Advisor

EVC/ CSC
02.2012 - 04.2015


  • Advised expertise in provider enrollment, claims review, research, and issue resolution.
  • Maintained compliance with Service Level Agreements and demonstrated knowledge of MMIS Fiscal Operations.
  • Processed credentialing applications to ensure compliance with regulatory standards and organizational policies.
  • Reviewed documentation for accuracy, ensuring timely processing of applications within established deadlines.
  • Trained new staff on credentialing systems and best practices, fostering a collaborative team environment.
  • Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
  • Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
  • Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
  • Expedited the onboarding process for new providers, ensuring timely completion of all required documentation and verifications.


Case Manager

TASC
01.2005 - 04.2009
  • Coordinated client care plans for effective service delivery and resource allocation.
  • Assessed client needs via interviews, creating tailored support strategies.
  • Facilitated communication among clients, families, and providers to enhance collaboration.
  • Monitored case progress, adjusting interventions for optimal outcomes.
  • Mentored junior managers on complex cases and career development.
  • Led team meetings to evaluate client progress and plan next steps.
  • Educated clients on programs and benefits, enabling informed care decisions.

Education

Sociology

Winston-Salem State University
Winston-Salem, NC
05-2007

Skills

  • Operational efficiency
  • Financial Reporting
  • Documentation review
  • Internal auditing
  • Multitasking Abilities
  • Team building
  • Analytical skills
  • Problem-solving
  • Time management
  • Attention to detail
  • Reliability

Timeline

Internal Control Analyst Associate

GDiT
03.2022 - Current

Healthcare Claims Administrator III

CSRA/GDIT
04.2015 - 03.2022

Credentialing Advisor

EVC/ CSC
02.2012 - 04.2015

Case Manager

TASC
01.2005 - 04.2009

Sociology

Winston-Salem State University
Cheron Coleman