Charlene Harris brings to Gorman Health Group ten years of diverse healthcare experience.  She has extensive knowledge in provider services, health insurance and government programs with expertise in Medicare operations. Since joining Gorman Health Group, she has utilized her Medicare experience to help GHG clients reconcile their enrollment claims and prescription drug claims, thus reducing their financial liability to CMS.

Charlene is a former CMS Managed Care Operations Specialist in the Chicago regional office and most recently a Medicare Advantage Plan Manager in the Atlanta regional office. She has provided specialized technical support to ten managed care organizations, which included Cost, Local PPO, PFFS and HMO/POS, SNPs and PDPs. Her Medicare managed care experience includes:

• Evaluating Service Area Expansions and initial applications to ensure that adequate procedures are in place to service members in accordance with the respective Standard Operating Procedures.
• Assuring the design and development of performance requirements for MMA plans.
• Implementing on-site performance monitoring for claims, appeals/grievance, enrollment/disenrollment, and provider contracting procedures using the Monitoring Guide Version 4 and the Monitoring SOP.
• Reviewing, approving and monitoring all pre- and post- enrollment correspondences with Medicare members and Corrective Action Plans.
• Conducting site visits for initial applications, post contract awards and biennial monitoring reviews.
• Advising managed care organizations on the CMS Medicare Prescription Drug program regulations and program guidance.
• Assisting PDPs and MA-PDs with the implementation and operations in the area of marketing, enrollment, disenrollment and claims and appeals and grievances payment.

She has also developed an extensive knowledge base in Medicare and Medicaid operations from a provider services perspective during her years at HCA Patient Account Services as a Patient Access Supervisor for one of their leading Medicare and Medicaid facilities in Georgia.

Charlene holds a master’s degree from the University of Illinois at Chicago in Public Health Policy and Administration.  She currently resides in West Georgia.