Cheryl Clark Adegbembo
Hutto
Summary
Experienced Program Specialist skilled in auditing, compliance management, and disaster response oversight. Demonstrates a strong ability to analyze program expenditures, manage investigations into allegations of fraud, and develop actionable strategies to improve operational efficiencies and ensure regulatory adherence.
Overview
1
1
Certification
24
24
years of professional experience
Work History
Program Specialist III
Texas Health and Human Services Commission
Austin
05.2023 - Current
- Disaster Assistance Closeout: Manage financial reconciliations, compliance audits, and program closeout procedures for federal disaster declarations (e.g., DR 4781 and DR 4798) to successfully finalize grant lifecycles.
- Repatriation: Oversee and coordinate emergency financial and logistical assistance protocols for U.S. citizens returning from foreign crises or evacuations, ensuring adherence to federal assistance guidelines, seamless inter-agency collaboration, and accurate tracking of eligible recovery funds.
- Audit & Review: Perform comprehensive audits of financial records, grant disbursements, and procurement documentation to ensure compliance with Federal (e.g., FEMA) and State regulations.
- Overpayment Management: Reviewed and validated assistance overpayment allegations, calculated overpayment amounts, initiated recovery processes, and documented violations, ensuring compliance and accountability.
- Budget Integrity: Analyzed program expenditures to identify trends and potential misuse of funds; prepared detailed financial reports for executive leadership, enhancing decision-making on resource allocation.
- Complex Case Resolution: Serve as the final point of escalation for high-risk or politically sensitive investigations involving suspected fraud or sophisticated noncompliance.
- Systemic Problem Solving: Identify and resolve bottlenecks in the disaster assistance lifecycle; lead the development of 'corrective action plans' when internal audits reveal process failures.
- Policy Interpretation: Translate complex statutory and regulatory language into actionable guidance for staff and stakeholders.
- Expert Testimony: Prepare case files for administrative hearings, state-level reviews, or legal proceedings, and serve as the department representative to defend programmatic decisions.
Provider Investigator IV
Texas Health and Human Services Commission
Austin
08.2022 - 05.2023
- Regulatory Investigations: Conducted comprehensive, complex investigations into allegations of abuse, neglect, and exploitation of vulnerable populations within Long-Term Care Regulation (LTCR) facilities.
- Evidence Collection & Analysis: Collected and analyzed medical records, facility documentation, and witness statements; interviewed residents, witnesses, and facility staff to establish factual findings for investigations.
- Policy Compliance & Reporting: Assessed facility operations and standard operating procedures against state and federal regulatory frameworks to identify statutory violations and evaluate associated risk levels.
- Case Management & Documentation: Authored detailed, legally defensible investigative reports and summary findings within strict statutory timelines to support enforcement actions and administrative reviews.
- Interagency Collaboration: Collaborated with law enforcement, legal teams, and state regulatory agencies to coordinate responses to critical incidents and severe non-compliance, enhancing overall investigative effectiveness.
- (LTCR Division)
Investigator III / Supervisor
Texas Health and Human Services Commission
Austin
01.2018 - 08.2022
- Created policies and procedures for investigating complex fraud cases involving disaster assistance grant checks.
- Investigate fraud of State and Government grant program.
- Oversee the management of disaster assistance related investigations.
- Established administrative control for fund expenditure management, ensuring compliance and justifying state and federal reimbursements for disaster-related expenses.
- Planned, coordinated, and monitored service delivery in assigned areas, enhancing operational effectiveness and ensuring program compliance.
- Develop and maintain accounting systems, control policies, procedures and records in conformance with state and federal standards.
- Executed payment file processing to facilitate accurate and efficient claims handling. and Import Claims for payment.
- Collect overpayments of Disaster Assistance Grant funds in conformance with Federal and State guidelines.
Staffing Coordinator
Girling Community Care
Austin
01.2017 - 01.2018
- Coordinated recruitment efforts for potential attendants through phone outreach, community events, and placement advertisements.
- Scheduled caregivers for client assignments based on employee availability and client needs.
- Collaborated with Case Managers to address caregiver schedule changes and resolve concerns promptly.
- Communicating and confirming schedules, including any changes, with staff and caregivers.
- Overseeing caregivers' coaching, evaluations, and trainings.
- Assisted payroll coordinator in processing time sheets for payment and helped deal with payroll problems, follow-up, and tracked outstanding time-sheet list.
- Follow up with payroll coordinator to ensure correct and complete service interruptions and/or suspensions ensure suspensions are documented.
- Perform reference checks and misconduct checks of applicants.
- Conducted follow-up calls with new hires to confirm receipt of essential onboarding information. to new hires.
Refund Specialist/Billing and Collections
Seton Healthcare Family
Austin
07.2005 - 07.2017
- Review, research and analyze accounts receivable credit balances (patients and insurance carriers).
- Identify and investigate credit balances to determine appropriate refund amount.
- Utilize managed care contracts to determine the accuracy of refunds processed.
- Submit refund request for claims paid in error.
- Write up credits that were on patient's accounts and send them over to accounts payable to issue a check.
- Applied managed care, charity, and government adjustments.
- Communicated extensively with health insurance carriers to address inconsistencies in credit balances.
- Submits disputes to health insurance carriers when refund requests are inconsistent with manage care contracts.
- Identifies and investigate Government Credits to determine if a refund is the appropriate course of action.
- Led special projects to resolve aged credit balances through audits and reports. to resolve target aged credit balances (audits and reports).
- Maintains updated refund material that assists with refund processes for refund team.
- Remains up to date with all insurance requirements, including the details of patient financial responsibilities, fee for service, government and managed care plans.
- Maintains knowledge and ability to perform any role under the given revenue cycle supervisor.
- Research insurance and patient refunds.
Provider Relations Representative and Credentialing Specialist
Amil International
Austin
04.2002 - 07.2005
- Built and maintained professional relationships with providers, enhancing customer service and fostering collaboration.
- Negotiated and managed care contracts, ensuring compliance with Medicare/Medicaid regulations and healthcare administration standards.
- Managed end-to-end provider credentialing and re-credentialing cycles, ensuring strict adherence to state, federal, and managed care regulatory standards.
- Verified professional licenses, certifications, work histories, and malpractice insurance to maintain compliance and mitigate risk.
- Streamlined provider onboarding documentation and optimized operational queues, accelerating credential review and approval processes.
- Acted on correspondence received; submitted appeals, obtained corrected information, requesting rebills, coordinated requests for medical records and posting account adjustments Exceptional ability to maintain confidentiality and security.
- Conducted periodic audits for all business units to identify continuous network requirements.
- Served as team liaison during supervisor and manager absences, facilitating communication and coordination among team members.
Education
Bachelor of Science - Human Services (Child and Family Welfare)
Purdue University Global
West Lafayette, IN04-2018
High School Diploma -
Reagan High School
Austin, TX06-1987
Skills
- Regulatory compliance
- Compliance auditing
- Program management
- Grant management
- Data collection and research
- Process improvement
- Billing management
- Payment management
- Stakeholder engagement
- Team collaboration
- Customer service
- Program management
Certification
- Driver's License, 15756848, 12/01/25 to 12/01/30
- Certified Notary Public, 11/01/23 to 11/01/27
Additional Information
Authorized to work in the US for any employer, Strong office staff supervisory, interpersonal, and management abilities, Excellent familiar with local, state and federal laws, and finance and federal occupational laws, Exceptional ability to maintain client assessment and analysis confidentiality and security, Strong skills in developing policy, report writing, and building strong written communication and profitable working relationships
Computerized Programs
- National Emergency Management Information Systems (NEMIS)
- Microsoft Suite
- Disaster Assistance Payment Program (DAPP)
- Centralized Accounting Payroll/Personnel System (CAPPS)
- Uniform Statewide Accounting Systems (USAS)
- Genesys
Timeline
Program Specialist III
Texas Health and Human Services Commission
05.2023 - Current
Provider Investigator IV
Texas Health and Human Services Commission
08.2022 - 05.2023
Investigator III / Supervisor
Texas Health and Human Services Commission
01.2018 - 08.2022
Staffing Coordinator
Girling Community Care
01.2017 - 01.2018
Refund Specialist/Billing and Collections
Seton Healthcare Family
07.2005 - 07.2017
Provider Relations Representative and Credentialing Specialist
Amil International
04.2002 - 07.2005
Bachelor of Science - Human Services (Child and Family Welfare)
Purdue University Global
High School Diploma -
Reagan High School