Whitney Rochelle
Alexandria,VA
Summary
Empathetic Senior Case Manager with 10 years of experience in clinical case management. Proactive in solving client needs effectively, simultaneously engaging personally in case work. Compassionate professional giving back to community through service to others.
Overview
28
28
years of professional experience
1
1
Certification
Work History
PCA Personal Care Assistant
Care Advantage
Fredericksburg, VA
09.2020 - Current
- Monitored client vital signs, administered medications and tracked behaviors to keep healthcare supervisor well-informed.
- Recorded temperature, blood pressure, pulse, or respiration rate as directed by medical or nursing staff.
- Assisted with daily living activities, running errands and household chores.
- Maintained clean personal areas and prepared healthy meals to support client nutritional needs.
- Maintained frequent supervision of residents unable to call for assistance.
- Assisted patients with self-administered medications.
- Remained alert to problems or health issues of clients and competently responded.
- Conferred with supervisor to discuss patient condition and medical care.
Liability Claims Adjuster
GEICO
Fredericksburg, VA
09.2020 - 03.2021
- Investigating, review, research auto claims and determining liability
- Review police reports, administer recorded interviews
- Negotiate claim settlements oversee that claims are paid out to policyholders
- Data collection per claim
- Examined claims forms and other records to determine insurance coverage.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Followed up with insured individuals regarding premium and deductibles payments.
- Synthesized data into comprehensive quarterly written reports for management.
- Investigated legal issues pertaining to auto claims.
- Compared data from surveillance footage to data on medical reports.
- Trained other claims staff members on proper handling and evaluation of injury claims.
- Negotiated auto settlement agreements to resolve disputes.
- Investigated claims involving potential and suspected fraudulent activities.
- Drafted investigative reports covering phases of investigation in each case.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Managed caseload of 9-11 new claims daily
Clinical Administrative Assistant
Merrifield Center
Fairfax, VA
03.2020 - 08.2020
- Utilization Management
- Recoup funds from insurance companies for mental health services provided to clients
- Adjust payment request according to medical billing and coding standards
- Adjudicates claims for mental health department
- Submit prior authorizations for services
- Reviewing claim submissions and verifying the information
- Recording and maintaining insurance policy and claims information in database system
- Determining policy coverage and calculating claim amounts
- Processing claim payments
- Complying with federal, state, and company regulations and policies
- Performing other clerical tasks, as required.
- Answered phone calls and messages for physicians in mental health medical facility, scheduling appointments and handling patient inquiries.
PCA Personal Care Assistant
Always Best Care Senior Services
Burlington, NC
11.2014 - 08.2020
- Assist residents in home with ADLs and did live in cases
- Scheduled and accompanied clients to medical appointments.
- Recorded temperature, blood pressure, pulse, or respiration rate as directed by medical or nursing staff.
- Helped clients maintain optimal health by overseeing medication administration and doctor's appointments.
- Monitored and assisted residents through individual service plans.
- Assisted patients with self-administered medications.
- Helped patients care for themselves by teaching proper, safe use of ambulation assistive devices such as canes or walkers.
- Supported clients with mental support and physical activities to accomplish quality of life and sustain needs.
Licensed Insurance Agent
American Insurance Organization
Orlando, FL
11.2019 - 03.2020
- For Fl, SC, MI, MD, OH, NC
- Primary sales for Life, Health, and Annuities as independent broker
- Collect customers medical history and determine which insurance is right for them
- Provided coverage option information to assist clients in protecting assets.
- Exceeded corporate quotas for monthly policy sales.
- Upsold additional products and services after identifying customer needs and requirements.
- Reported policy changes and company conditions affecting customer satisfaction.
- Attended continuing education courses and workshops to gain additional insurance industry knowledge.
- Leveraged knowledge of company insurance products and services to advise customers on appropriate choices.
- Developed sales leads from direct referrals, networking and targeted marketing campaigns.
- Calculated quotes and educated potential clients on insurance options.
Senior Resolutions Representative
CVS Health
Orlando, FL
10.2016 - 08.2019
- Work from home Position, Responsible for Virtual trainings and Virtual Meetings
- Responsible for acting as a liaison between customers and CVS Health Commercial RX insurance
- Assists clients via live chats to organize delivery of meds and to troubleshoot any issues with Rx orders or scripts
- Assists with complaints, orders, errors, account questions, billing, cancelation, and other queries regarding commercial prescription insurance plans
- Communicate with doctor offices to get scripts corrected and prior authorizations
- Verified eligibility of benefits and worked with specialty pharmacy to fulfill orders
- Processed commercial pharmacy insurance claims
- Assisted the first 3 virtual Orlando commercial work from home training classes serving as a PAL/SME and assisted in facilitating debriefs during their onboarding
- Project Management for Escalations team
- Actively participated in numerous focus groups at the Orlando Fl site, providing in-site to management platform
- Serves as team Champion on current team assist supervisor with keeping team members informed of changes and updates to Caremark Software
- Quality Assurance and call monitoring
- Maintained daily contact with project managers and IT personnel to deliver timely status updates.
- Listened to customers and negotiated solutions that met their needs.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Actively listened to customers' requests, confirming full understanding before addressing concerns.
- Worked with distressed customers to understand needs and provide excellent service.
Insurance Specialist
Florida Hospital Medical Group
Maitland, FL
01.2016 - 10.2016
- Collect and enter claim information
- Ensure all physicians are paid for services according to medical billing and coding systems
- Post insurance and patients and manage accounts, submit claims follow-up with carriers on unpaid and rejected claims
- Claim correction, practice Correspondence
- Responsible for charge correction and procedural code correction
- Answer patient inquiries on account status and charges
- Reports to billing supervisor
- Prepares appeals for claims
- Experience with all Insurance carriers verifications and prior authorizations
- Adjudicate claims for payment
- Worked with EPIC and Meditech programs for Billing
- Followed up on denials, late payments, extensions and other special circumstances.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
Crisis Intervention Team Coordinator
Wake Medical Hospital
Durham, NC
03.2013 - 08.2015
- Medicare/Medicaid patient verifications
- Insurance verification/authorizations
- Appeals/Denials/Claims
- Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client-centered
- Handle case assignments, draft service plans, review case progress and determine case closure, Help clients achieve wellness and autonomy
- Facilitate multiple care aspects (case coordination, information sharing, etc)
- Help patients make informed decisions by acting as their advocate regarding their clinical status and treatment options
- Develop effective working relations and cooperate with medical team throughout the entire case management process
- Arrange abeyances with social services, health and governmental agencies
- Record cases information, complete accurately all necessary forms and produce statistical reports
- Used skills such as active listening and collaborative problem-solving daily to connect with patients and address concerns.
- Counseled and helped to stabilize consumers and caregivers in crisis situations.
- Evaluated risk to client or others by gathering information and conducting assessments.
- Built safety plans to lower risk of crisis and intervened in specific manners outlined by procedures.
- Conversed with individuals in crisis which called or texted hotline for assistance.
Behavioral Health Specialist
Medical Staffing Network Healthcare LLC
Raleigh, NC
03.2013 - 07.2015
- Worked closely with adults and children in community settings, hospitals, at residential facilities and within homes.
- Conducted functional behavior assessments, functional analysis, preference assessments and assessments of basic learning and language skills to identify target behaviors and purpose of behaviors.
- Trained residential staff on symptoms management and intervention strategies for clients with various behavioral issues.
- Implemented and established behavior strategies by setting rules, reiterating expectations and rewarding good behavior for over 8 students.
- Created progress reports, assessments and charting within required timeframes.
- Identified appropriate treatment resources and recommended patients for these services.
Specimen Accessioner
Labcorp
Durham, NC
06.2013 - 03.2015
- Specimen Accessioner
- Sample intake, accessioning, logging samples into CRM databases
- Verifying Patient eligibility
- Aliquot specimens and collect data from donors
- Create sample batches and print labels and label tubes and batches
- Resolve and document incomplete or unacceptable specimens
- Maintained strict aseptic fields when collecting biological samples, minimizing staff and patient infection risks.
- Processed and managed approx 400 specimens daily
Patient Care Coordinator
Alliance Imaging Company
Durham, NC
03.2010 - 07.2014
- Screen, assist and prep patients for MRI testing
- Schedule/ confirm appointments
- Verify patient eligibility for physician orders (High volume)
- Sterilization of all medical equipment
- Responsible to get machine ready, before procedure of imaging
- Responsible to prepare patient for MRI imaging, collect medical history, do questionnaires and assist with dressing when needed
- Make sure that patient is still, so that exact imaging of body part could be done
- Adjusting different parameters of MRI machine
- Recording images of affected area/s of patient/Storing images
- Responsible to take care of all safety measures
- Established rapport and relationships with patients and external partners to cross-train and support medical staff.
- Reviewed each step of patient care and made proactive adjustments to avert issues.
- Facilitated communication between hospital departments.
- Met with patients and families to discuss care and plan of action for future.
- Encouraged patients to schedule recommended tests and procedures.
- Maintained confidentiality of patient data and condition to safeguard health information.
- Reviewed medical charts and served as liaison between patient, doctor and hospital.
Life Enrichment Director/CNA
Croasdaile Village Retirement Community
Durham, NC
09.2010 - 02.2012
- Assignment Completed)
- Plan, Organize and develops curriculum of activities and events to enhance lives of residents
- Implements activity programs offered to facility residents, and may also lead residents in these activities
- Plan and coordinate external activities for residents to participate in such as visits to local museums and cultural events
- Plan, organize and develop therapeutic recreational activities specific to resident's cognitive level and care plan
- Fill in as nursing assistant, assisting residents with activities of daily living
- Collaborated closely with residents, using effective communication to better understand favorite activities.
- Increased resident socialization through implementation of wide range of fun, educational and family-oriented activities.
- Provided one-on-one programs and activities for residents unable to participate in group settings.
- Led efforts to conceive, develop and execute thematically aligned entertainment programming.
CNA - Certified Nursing Assistant
Hillcrest Convalescent Center
Durham, NC
02.2008 - 11.2011
- Skilled Nursing facility, long term care, respite care, assisted those in rehabilitation unit with ADLs and therapy.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Evaluated patients to identify and address wounds, behavioral concerns and medically relevant symptoms.
- Delivered individualized patient care by recording vital signs, documenting observations, administering treatments and evaluating patient needs.
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
- Conferred with multidisciplinary healthcare team to help effectively manage patient conditions with regular testing and vitals assessments.
- Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
Education
Bachelor's - Biology
Meredith College
Raleigh, NC05.2009
Skills
- Relationship Building
- Needs Assessment
- Decision Making
- Team Collaboration
- Written and verbal communication
- Program development
- Proficient in Microsoft
- Analytical and Critical Thinking
Certification
February 2015 to Present CPR Certification
CNA May 2004 to July 2017 Certified Initially in NC
First Aid Certification
BLS for Healthcare Providers August 2021 to Present
- PCA - Personal Care Aide
- CNP - Certified Notary Public
Additional Information
References Available upon Request
Timeline
PCA Personal Care Assistant
Care Advantage
09.2020 - Current
Liability Claims Adjuster
GEICO
09.2020 - 03.2021
Clinical Administrative Assistant
Merrifield Center
03.2020 - 08.2020
Licensed Insurance Agent
American Insurance Organization
11.2019 - 03.2020
Senior Resolutions Representative
CVS Health
10.2016 - 08.2019
Insurance Specialist
Florida Hospital Medical Group
01.2016 - 10.2016
PCA Personal Care Assistant
Always Best Care Senior Services
11.2014 - 08.2020
Specimen Accessioner
Labcorp
06.2013 - 03.2015
Behavioral Health Specialist
Medical Staffing Network Healthcare LLC
03.2013 - 07.2015
Crisis Intervention Team Coordinator
Wake Medical Hospital
03.2013 - 08.2015
Life Enrichment Director/CNA
Croasdaile Village Retirement Community
09.2010 - 02.2012
Patient Care Coordinator
Alliance Imaging Company
03.2010 - 07.2014
CNA - Certified Nursing Assistant
Hillcrest Convalescent Center
02.2008 - 11.2011
Bachelor's - Biology
Meredith College